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Li XM, Yao DQ, Quan XY, Li M, Chen W, Wáng YXJ. Perfusion of hepatocellular carcinomas measured by diffusion-derived vessel density biomarker: Higher hepatocellular carcinoma perfusion than earlier intravoxel incoherent motion reports. NMR IN BIOMEDICINE 2024; 37:e5125. [PMID: 38361334 DOI: 10.1002/nbm.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
Diffusion-derived vessel density (DVDD) is a physiological surrogate of the area of microvessels per unit tissue area. DDVD is calculated according to DDVD(b0b2) = Sb0/ROIarea0 - Sb2/ROIarea2, where Sb0 and Sb2 refer to the liver signal when b is 0 or 2 s/mm2. Pathohistological studies and contrast-enhanced CT/MRI data showed higher blood volume in hepatocellular carcinoma (HCC) relative to native liver tissue. With intravoxel incoherent motion (IVIM) imaging, most authors paradoxically reported a decreased perfusion fraction of HCC relative to the adjacent liver. This study applied DDVD to assess the perfusion of HCC. MRI was performed with a 3.0-T magnet. Diffusion-weighted images with b-values of 0 and 2 s/mm2 were acquired in 72 HCC patients. Thirty-two patients had microvascular invasion (MVI(+)) and 40 patients did not have microvascular invasion (MVI(-)). Fifty-eight patients had Edmondson-Steiner grade I or II HCC, and 14 patients had Edmondson-Steiner grade III or IV HCC. DDVD measurement was conducted on the axial slice that showed the largest HCC size. DDVD(b0b2) T/L = HCC DDVD(b0b2)/liver DDVD(b0b2). DDVD(b0b2) T/L median (95% confidence interval) of all HCCs was 2.942 (2.419-3.522), of MVI(-) HCCs was 2.699 (2.030-3.522), of MVI(+) HCCs was 2.988 (2.423-3.990), of Edmondson-Steiner grade I/II HCCs was 2.873 (2.277-3.465), and of Edmondson-Steiner grade III/IV HCCs was 3.403 (2.008-4.485). DDVD(b0b2) T/L approximately agrees with contrast agent dynamically enhanced CT/MRI literature data, whereas it differs from earlier IVIM study results, where HCC perfusion fraction was paradoxically lower relative to native liver tissue. A weak trend was noted with MIV(+) HCCs had a higher DDVD(b0b2) T/L than that of MVI(-) HCCs, and a weak trend was noted with the poorly differentiated group of HCCs (Edmondson-Steiner grade III and IV) had a higher DDVD(b0b2) T/L than that of the better differentiated group of HCCs (Edmondson-Steiner grade I and II).
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Affiliation(s)
- Xin-Ming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dian-Qi Yao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xian-Yue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Min Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | | | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhang Y, Chen J, Yang C, Dai Y, Zeng M. Preoperative prediction of microvascular invasion in hepatocellular carcinoma using diffusion-weighted imaging-based habitat imaging. Eur Radiol 2024; 34:3215-3225. [PMID: 37853175 DOI: 10.1007/s00330-023-10339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Habitat imaging allows for the quantification and visualization of various subregions within the tumor. We aim to develop an approach using diffusion-weighted imaging (DWI)-based habitat imaging for preoperatively predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC). METHODS Sixty-five patients were prospectively included and underwent multi-b DWI examinations. Based on the true diffusion coefficient (Dt), perfusion fraction (f), and mean kurtosis coefficient (MK), which respectively characterize cellular density, perfusion, and heterogeneity, the HCCs were divided into four habitats. The volume fraction of each habitat was quantified. The logistic regression was used to explore the risk factors from habitat fraction and clinical variables. Clinical, habitat, and nomogram models were constructed using the identified risk factors from clinical characteristics, habitat fraction, and their combination, respectively. The diagnostic accuracy was evaluated using the area under the receiver operating characteristic curves (AUCs). RESULTS MVI-positive HCC exhibited a significantly higher fraction of habitat 4 (f4) and a significantly lower fraction of habitat 2 (f2) (p < 0.001), which were selected as risk factors. Additionally, tumor size and elevated alpha-fetoprotein (AFP) were also included as risk factors for MVI. The nomogram model demonstrated the highest diagnostic performance (AUC = 0.807), followed by the habitat model (AUC = 0.777) and the clinical model (AUC = 0.708). Decision curve analysis indicated that the nomogram model offered more net benefit in identifying MVI compared to the clinical model. CONCLUSIONS DWI-based habitat imaging shows clinical potential for noninvasively and preoperatively determining the MVI of HCC with high accuracy. CLINICAL RELEVANCE STATEMENT The proposed strategy, diffusion-weighted imaging-based habitat imaging, can be applied for preoperatively and noninvasively identifying microvascular invasion in hepatocellular carcinoma, which offers potential benefits in terms of prognostic prediction and clinical management. KEY POINTS • This study proposed a strategy of DWI-based habitat imaging for hepatocellular carcinoma. • The habitat imaging-derived metrics can serve as diagnostic markers for identifying the microvascular invasion. • Integrating the habitat-based metric and clinical variable, a predictive nomogram was constructed and displayed high accuracy for predicting microvascular invasion.
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Affiliation(s)
- Yunfei Zhang
- Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jiejun Chen
- Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chun Yang
- Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, 200032, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Li XM, Ma FZ, Quan XY, Zhang XC, Xiao BH, Wáng YXJ. Repeatability and reproducibility comparisons of liver IVIM imaging with free-breathing or respiratory-triggered sequences. NMR IN BIOMEDICINE 2024; 37:e5080. [PMID: 38113878 DOI: 10.1002/nbm.5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023]
Abstract
For liver intravoxel incoherent motion (IVIM) data acquisition, respiratory-triggering (RT) MRI is commonly used, and there are strong motivations to shorten the scan duration. For the same scan duration, more b values or higher numbers of excitations can be allowed for free-breathing (FB) imaging than for RT. We studied whether FB can be used to replace RT when careful IVIM image acquisition and image processing are conducted. MRI data of 22 healthy participants were acquired using a 3.0 T scanner. Diffusion imaging was based on a single-shot spin-echo-type echo-planar sequence and 16 b values of 0, 2, 4, 7, 10, 15, 20, 30, 46, 60, 72, 100, 150, 200, 400, and 600 s/mm2 . Each subject attended two scan sessions with an interval of 10-20 days. For each scan session, a subject was scanned twice, first with RT and then with FB. The mean image acquisition time was 5.4 min for FB and 10.8 min for RT. IVIM parameters were calculated with bi-exponential model segmented fitting with a threshold b value of 60 s/mm2 , and fitting started from b = 2 s/mm2 . There was no statistically significant difference between IVIM parameters measured with FB imaging or RT imaging. Perfusion fraction ICC (intraclass correlation coefficient) for FB imaging and RT imaging in the same scan session was 0.824. For perfusion fraction, wSD (within-subject standard deviation), BA (Bland-Altman) difference, BA 95% limit, and ICC were 0.022, 0.0001, -0.0635~0.0637, and 0.687 for FB and 0.031, 0.0122, -0.0723~0.0967, and 0.611 for RT. For Dslow (×10-3 s/mm2 ), wSD, BA difference, BA 95% limit, and ICC were 0.057, 0.0268, -0.1258~0.1793, and 0.471 for FB and 0.073, -0.0078, -0.2170-0.2014, and <0.4 for RT. The Dfast coefficient of variation was 0.20 for FB imaging and 0.28 for RT imaging. All reproducibility indicators slightly favored FB imaging.
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Affiliation(s)
- Xin-Ming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fu-Zhao Ma
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xian-Yue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xu-Chang Zhang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Woo S, Vargas HA. Editorial for "Efficiency and Accuracy Evaluation of Multiple Diffusion-Weighted MRI Techniques Across Different Scanners". J Magn Reson Imaging 2024; 59:323-324. [PMID: 37367223 DOI: 10.1002/jmri.28873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, New York, New York, USA
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Song M, Wang Q, Feng H, Wang L, Zhang Y, Liu H. Preoperative Grading of Rectal Cancer with Multiple DWI Models, DWI-Derived Biological Markers, and Machine Learning Classifiers. Bioengineering (Basel) 2023; 10:1298. [PMID: 38002422 PMCID: PMC10669695 DOI: 10.3390/bioengineering10111298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Background: this study aimed to utilize various diffusion-weighted imaging (DWI) techniques, including mono-exponential DWI, intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for the preoperative grading of rectal cancer. Methods: 85 patients with rectal cancer were enrolled in this study. Mann-Whitney U tests or independent Student's t-tests were conducted to identify DWI-derived parameters that exhibited significant differences. Spearman or Pearson correlation tests were performed to assess the relationships among different DWI-derived biological markers. Subsequently, four machine learning classifier-based models were trained using various DWI-derived parameters as input features. Finally, diagnostic performance was evaluated using ROC analysis with 5-fold cross-validation. Results: With the exception of the pseudo-diffusion coefficient (Dp), IVIM-derived and DKI-derived parameters all demonstrated significant differences between low-grade and high-grade rectal cancer. The logistic regression-based machine learning classifier yielded the most favorable diagnostic efficacy (AUC: 0.902, 95% Confidence Interval: 0.754-1.000; Specificity: 0.856; Sensitivity: 0.925; Youden Index: 0.781). Conclusions: utilizing multiple DWI-derived biological markers in conjunction with a strategy employing multiple machine learning classifiers proves valuable for the noninvasive grading of rectal cancer.
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Affiliation(s)
- Mengyu Song
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Qi Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Hui Feng
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Lijia Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai 201800, China
| | - Hui Liu
- Department of Radiology, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang 050000, China
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Wang Q, Yu G, Qiu J, Lu W. Application of Intravoxel Incoherent Motion in Clinical Liver Imaging: A Literature Review. J Magn Reson Imaging 2023. [PMID: 37908165 DOI: 10.1002/jmri.29086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Intravoxel incoherent motion (IVIM) modeling is a widely used double-exponential model for describing diffusion-weighted imaging (DWI) signal, with a slow component related to pure molecular diffusion and a fast component associated with microcirculatory perfusion, which compensates for the limitations of traditional DWI. IVIM is a noninvasive technique for obtaining liver pathological information and characterizing liver lesions, and has potential applications in the initial diagnosis and treatment monitoring of liver diseases. Recent studies have demonstrated that IVIM-derived parameters are useful for evaluating liver lesions, including nonalcoholic fatty liver disease (NAFLD), liver fibrosis and liver tumors. However, the results are not stable. Therefore, it is necessary to summarize the current applications of IVIM in liver disease research, identify existing shortcomings, and point out the future development direction. In this review, we searched for studies related to hepatic IVIM-DWI applications over the past two decades in the PubMed database. We first introduce the fundamental principles and influential factors of IVIM, and then discuss its application in NAFLD, liver fibrosis, and focal hepatic lesions. It has been found that IVIM is still unstable in ensuring the robustness and reproducibility of measurements in the assessment of liver fibrosis grade and liver tumors differentiation, due to inconsistent and substantial overlap in the range of IVIM-derived parameters for different fibrotic stages. In the end, the future direction of IVIM-DWI in the assessment of liver diseases is discussed, emphasizing the need for further research on the stability of IVIM-derived parameters, particularly perfusion-related parameters, in order to promote the clinical practice of IVIM-DWI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Qi Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Guanghui Yu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
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Sheng Y, Dang X, Zhang H, Rui W, Wang J, Cheng H, Qiu T, Zhang Y, Ding Y, Yao Z, Pang H, Ren Y. Correlations between intravoxel incoherent motion-derived fast diffusion and perfusion fraction parameters and VEGF- and MIB-1-positive rates in brain gliomas: an intraoperative MR-navigated, biopsy-based histopathologic study. Eur Radiol 2023; 33:5236-5246. [PMID: 36941492 DOI: 10.1007/s00330-023-09506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/23/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To explore the correlations between histopathologic findings and intravoxel incoherent motion (IVIM)-derived perfusion and diffusion parameters in brain gliomas. METHODS Thirty-two biopsy samples from twenty-one patients with newly diagnosed gliomas from a previous prospective cohort study were retrospectively analyzed. All patients underwent diffusion-weighted MRI with 22 b values (0-5000 s/mm2), followed by intraoperative MR-guided biopsy surgery and surgical resection. All 32 biopsy samples underwent immunohistochemical staining followed by quantitative analysis of cell density (cellularity), percent of MIB-1 (Ki67)-positive expression (pMIB-1), number of CD34-stained vessels (CD34-MVD), and percent of VEGF-positive expressing cells (pVEGF) using a multispectral phenotyping microscope. Based on the co-registered localized biopsy, correlation analysis was performed between the IVIM-derived biexponential model-based parameters (Dfast1500 and Dfast5000, Dslow1500 and Dslow5000, PF1500 and PF5000) and the above four pathological biomarkers and glioma grades. RESULTS Significant positive correlations were revealed between Dfast5000 and pVEGF (rho (r) = 0.466, p = 0.007), and Dfast1500 and pVEGF (r = 0.371, p = 0.037). A significant negative correlation was revealed between PF5000 with pMIB-1 (r = - 0.456, p = 0.01). Moderate to good positive correlations were shown between Dfast5000 and glioma grades (r = 0.509, p = 0.003) and Dfast1500 and glioma grades (r = 0.476, p = 0.006). CONCLUSIONS IVIM-DWI-derived Dfast and PF correlate, respectively, with intratumor pVEGF and pMIB-1. When using the wide-high b value scheme, IVIM-derived Dfast and PF tend to demonstrate better efficacy in evaluating malignancy-related characteristics such as angiogenesis and cellular proliferation in gliomas. KEY POINTS • Intravoxel incoherent motion-diffusion-weighted imaging (IVIM-DWI)-derived fast diffusion (Dfast) and perfusion fraction (PF) can quantitatively reflect intratumor pVEGF and pMIB-1. • IVIM-DWI-derived Dfast and PF tend to demonstrate better efficacy in evaluating glioma malignancy when an optimized scheme is used. • IVIM-DWI-derived Dfast5000 and PF5000 are promising non-invasive parameters correlating with pVEGF and pMIB-1 in gliomas.
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Affiliation(s)
- Yaru Sheng
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xuefei Dang
- Department of Oncology, Minhang Branch of Fudan University Shanghai Cancer Center, Shanghai, 200240, China
| | - Hua Zhang
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Wenting Rui
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jing Wang
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haixia Cheng
- Neuropathology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Tianming Qiu
- Neurosurgery Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yong Zhang
- MR Research, GE Healthcare, 1 Huatuo Road, Shanghai, 201203, China
| | - Yueyue Ding
- Department of Echocardiology, Children's Hospital, Suzhou University, Suzhou, 215000, China
| | - Zhenwei Yao
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haopeng Pang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, #197 Rui Jin Er Road, Shanghai, 200025, China.
- Department of Integrative Oncology, Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Radiology Department of Huashan Hospital, Fudan University, Mid 12 Wulumuqi Road, Shanghai, 200040, China.
| | - Yan Ren
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Li C, Wen Y, Xie J, Chen Q, Dang Y, Zhang H, Guo H, Long L. Preoperative prediction of VETC in hepatocellular carcinoma using non-Gaussian diffusion-weighted imaging at high b values: a pilot study. Front Oncol 2023; 13:1167209. [PMID: 37305565 PMCID: PMC10248416 DOI: 10.3389/fonc.2023.1167209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background Vessels encapsulating tumor clusters (VETC) have been considered an important cause of hepatocellular carcinoma (HCC) metastasis. Purpose To compare the potential of various diffusion parameters derived from the monoexponential model and four non-Gaussian models (DKI, SEM, FROC, and CTRW) in preoperatively predicting the VETC of HCC. Methods 86 HCC patients (40 VETC-positive and 46 VETC-negative) were prospectively enrolled. Diffusion-weighted images were acquired using six b-values (range from 0 to 3000 s/mm2). Various diffusion parameters derived from diffusion kurtosis (DK), stretched-exponential (SE), fractional-order calculus (FROC), and continuous-time random walk (CTRW) models, together with the conventional apparent diffusion coefficient (ADC) derived from the monoexponential model were calculated. All parameters were compared between VETC-positive and VETC-negative groups using an independent sample t-test or Mann-Whitney U test, and then the parameters with significant differences between the two groups were combined to establish a predictive model by binary logistic regression. Receiver operating characteristic (ROC) analyses were used to assess diagnostic performance. Results Among all studied diffusion parameters, only DKI_K and CTRW_α significantly differed between groups (P=0.002 and 0.004, respectively). For predicting the presence of VETC in HCC patients, the combination of DKI_K and CTRW_α had the larger area under the ROC curve (AUC) than the two parameters individually (AUC=0.747 vs. 0.678 and 0.672, respectively). Conclusion DKI_K and CTRW_α outperformed traditional ADC for predicting the VETC of HCC.
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Affiliation(s)
- Chenhui Li
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yan Wen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jinhuan Xie
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qianjuan Chen
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yiwu Dang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthcare Ltd., Wuhan, Hubei, China
| | - Hu Guo
- MR Application, Siemens Healthcare Ltd., Changsha, Hunan, China
| | - Liling Long
- Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Gaungxi Medical University, Ministry of Education, Nanning, Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Ren Y, Chen L, Yuan Y, Xu J, Xia F, Zhu J, Shen W. Evaluation of renal cold ischemia-reperfusion injury with intravoxel incoherent motion diffusion-weighted imaging and blood oxygenation level-dependent MRI in a rat model. Front Physiol 2023; 14:1159741. [PMID: 37284547 PMCID: PMC10240072 DOI: 10.3389/fphys.2023.1159741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose: Cold ischemia-reperfusion injury (CIRI) is one of the most serious complications following renal transplantation. The current study investigated the feasibility of Intravoxel Incoherent Motion (IVIM) imaging and blood oxygenation level-dependent (BOLD) in the evaluation of different degrees of renal cold ischemia-reperfusion injury in a rat model. Methods: Seventy five rats were randomly divided into three groups (N = 25 for each group): T0: sham-operated group, T2/T4: CIRI groups with different cold ischemia hours (2, 4 h, respectively). The rat model of CIRI group was established by left kidney cold ischemia with right nephrectomy. All the rats received a baseline MRI before the surgery. Five rats in each group were randomly selected to undergo an MRI examination at 1 h, day 1, day 2 and day 5 after CIRI. The IVIM and BOLD parameters were studied in the renal cortex (CO), the outer stripe of the outer medulla (OSOM), and the inner stripe of the outer medulla (ISOM) followed by histological analysis to examine Paller scores, peritubular capillary (PTC) density, apoptosis rate and biochemical indicators to obtain the contents of serum creatinine (Scr), blood urea nitrogen (BUN), superoxide dismutase (SOD) and malondialdehyde (MDA). Results: The D, D*, PF and T2* values in the CIRI groups were lower than those in the sham-operated group at all timepoints (all p < 0.05). The prolonged cold ischemia times resulted in gradually lower D, D*, PF and T2* values (all p < 0.05). The D and T2* values of cortex and OSOM in Group T0 and T2 returned to the baseline level (all p > 0.05) except Group T4. The D* and PF values of cortex, OSOM and ISOM in Group T2 and T4 still remained below the normal levels (all p < 0.05) except Group T0. D, D*, PF and T2* values were strongly correlated with histopathological (Paller scores, PTC density and apoptosis rate) and the biochemistry indicators (SOD and MDA) (|r|>0.6, p < 0.001). D*, PF and T2* values were moderately to poorly correlated with some biochemistry indicators (Scr and BUN) (|r|<0.5, p < 0.05). Conclusion: IVIM and BOLD can serve as noninvasive radiologic markers for monitoring different degrees of renal impairment and recovery after renal CIRI.
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Affiliation(s)
- Yan Ren
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Lihua Chen
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Yizhong Yuan
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jipan Xu
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin Medical University First Central Hospital, Tianjin, China
| | - Fangjie Xia
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin Medical University First Central Hospital, Tianjin, China
| | - Jinxia Zhu
- MR Collaborations, Siemens Healthcare Ltd., Beijing, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
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Meng X, Tian S, Zhang Q, Chen L, Lin L, Li J, Shen Z, Wang J, Zhang Y, Song Q, Liu A. Improved differentiation between endometrial carcinoma and endometrial polyp with combination of APTw and IVIM MR imaging. Magn Reson Imaging 2023; 102:43-48. [PMID: 37054801 DOI: 10.1016/j.mri.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To assess the value of amide proton transfer weighted (APTw) combined with intra-voxel-incoherent-motion (IVIM) imaging in differential diagnosis of stage I-II endometrial carcinoma (EC) and endometrial polyp (EP). METHODS A total of 53 female patients (37 cases with EC and 16 cases with EP) confirmed by surgical resection or biopsy from June 2019 to Jan. 2022 were retrospectively reviewed. All patients underwent 3.0 T magnetic resonance imaging (MRI) examination including diffusion weighted imaging (DWI), APTw and IVIM scans. The pure diffusion coefficient (D), pseudo-diffusion coefficient (D⁎), perfusion fraction (f), apparent diffusion coefficient (ADC) and APT values were independently measured by two observers. Intra-class correlation coefficients (ICC) were used to test the consistency of measurements by the two observers. Mann-Whitney U test was performed to analyze the difference of each parameter between EC and EP groups. Receiver operator characteristic (ROC) analysis was performed, and the Delong test was used for ROC curve comparison. Pearson's correlation analysis was used to assess the correlation between APTw and IVIM parameters. RESULTS There was no significant difference in clinical manifestations between the two groups (P > 0.05). APT and D⁎ values of the EC group were significantly higher than those of the EP group [APT: 2.64 ± 0.50% vs. 2.05 ± 0.58%; and D⁎: (54.06 ± 36.06) × 10-3 mm2/s vs. (30.54 ± 16.67) × 10-3 mm2/s]. D, f and ADC values of EC group were significantly lower than those of EP group [D: 0.62(0.53,0.76) × 10-3 mm2/s vs. (1.45 ± 0.48) × 10-3 mm2/s; f: 22.18 ± 8.08% vs. 30.80 ± 8.92%; and ADC: (0.88 ± 0.16) × 10-3 mm2/s vs. (1.57 ± 0.43) × 10-3 mm2/s]. The area under ROC curves were observed as: AUC (IVIM+APT) > AUC (D) > AUC (ADC) > AUC (APT) > AUC (f) > AUC (D⁎). Delong test suggested statistical significance between AUC by APT and D, D and D⁎, D and f, D⁎ and ADC, APT and com(IVIM+APT), D⁎ and com(IVIM+APT), as well as f and com(IVIM+APT). No significant correlation between the APT and IVIM parameters was observed in either EC or EP group. CONCLUSION Both APT and IVIM parameters showed statistical differences between EC and EP. With combination of APT and IVIM parameters, the diagnostic accuracy between EC and EP can be significantly improved.
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Affiliation(s)
- Xing Meng
- Dalian Women and Children's Medical Group, Dalian, Liaoning 116033, China
| | - Shifeng Tian
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Qinhe Zhang
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Lihua Chen
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China; Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Liangjie Lin
- Advanced Technical Support, Philips Healthcare, Beijing 100600, China.
| | - Jin Li
- Advanced Technical Support, Philips Healthcare, Beijing 100600, China.
| | - Zhiwei Shen
- Advanced Technical Support, Philips Healthcare, Beijing 100600, China; Advanced Technical Support, Philips Healthcare, Beijing 100600, China.
| | - Jiazheng Wang
- Advanced Technical Support, Philips Healthcare, Beijing 100600, China; Advanced Technical Support, Philips Healthcare, Beijing 100600, China.
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang 310000, China.
| | - Qingwei Song
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Ailian Liu
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
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Yao R, Cheng A, Zhang Z, Jin B, Yu H. Correlation Between Apparent Diffusion Coefficient and the Ki-67 Proliferation Index in Grading Pediatric Glioma. J Comput Assist Tomogr 2023; 47:322-328. [PMID: 36957971 PMCID: PMC10045956 DOI: 10.1097/rct.0000000000001400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
OBJECTIVE This study aimed to investigate the correlation between apparent diffusion coefficient (ADC) and the Ki-67 proliferation index with the pathologic grades of pediatric glioma and to compare their diagnostic performance in differentiating grades of pediatric glioma. PATIENTS AND METHODS Magnetic resonance imaging examinations and histopathologies of 121 surgically treated pediatric gliomas (87 low-grade gliomas [LGGs; grades 1 and 2] and 34 high-grade gliomas [HGGs; grades 3 and 4]) were retrospectively reviewed. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and value of the Ki-67 proliferation index of LGGs and HGGs were compared. Correlation coefficients were calculated for ADC parameters and Ki-67 values. The receiver operating characteristic curve was used to determine the diagnostic value of ADCmean, ADCmin, ADC ratio, and Ki-67 proliferation index for differentiating LGGs and HGGs. RESULTS The ADC values were significantly negatively correlated with glioma grade, and the Ki-67 proliferation index had a significant positive correlation with glioma grade. A significant negative correlation was observed between ADCmean and Ki-67 proliferation index, between ADCmin and Ki-67 proliferation index, and between ADC ratio and Ki-67 proliferation index. The receiver operating characteristic analysis demonstrated moderate to good accuracy for ADCmean in discriminating LGGs from HGGs (area under the curve [AUC], 0.875; sensitivity, 79.3%; specificity, 82.4%; accuracy, 80.2%; positive predictive value [PPV], 92.0%; and negative predictive value [NPV], 60.9% [cutoff value, 1.187] [×10-3 mm2/s]). Minimum tumor ADC showed very good to excellent accuracy with AUC of 0.946, sensitivity of 86.2%, specificity of 94.1%, accuracy of 88.4%, PPV of 97.4%, and NPV of 72.7% (cutoff value, 0.970) (×10-3 mm2/s). The ADC ratio showed moderate to good accuracy with AUC of 0.854, sensitivity of 72.4%, specificity of 88.2%, accuracy of 76.9%, PPV of 94.0%, and NPV of 55.6% (cutoff value, 1.426). For the parameter of the Ki-67 proliferation index, in discriminating LGGs from HGGs, very good to excellent diagnostic accuracy was observed (AUC, 0.962; sensitivity, 94.1%; specificity, 89.7%; accuracy, 90.9%; PPV, 97.5%; and NPV, 78.0% [cutoff value, 7]). CONCLUSIONS Apparent diffusion coefficient parameters and the Ki-67 proliferation index were significantly correlated with histological grade in pediatric gliomas. Apparent diffusion coefficient was closely correlated with the proliferative potential of pediatric gliomas. In addition, ADCmin showed superior performance compared with ADCmean and ADC ratio in differentiating pediatric glioma grade, with a close diagnostic efficacy to the Ki-67 proliferation index.
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Affiliation(s)
- Rong Yao
- From the Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine
| | - Ailan Cheng
- Department of Radiology, Shanghai East Hospital Affiliated to Tongji University
| | - Zhengwei Zhang
- Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biao Jin
- Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Yu
- From the Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine
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Yue X, Lu Y, Jiang Q, Dong X, Kan X, Wu J, Kong X, Han P, Yu J, Li Q. Application of Intravoxel Incoherent Motion in the Evaluation of Hepatocellular Carcinoma after Transarterial Chemoembolization. Curr Oncol 2022; 29:9855-9866. [PMID: 36547188 PMCID: PMC9776688 DOI: 10.3390/curroncol29120774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: To assess the efficacy of the quantitative parameters of intravoxel incoherent motion (IVIM) diffusion-weighted imaging for hepatocellular carcinoma (HCC) diagnosis after transarterial chemoembolization (TACE). (2) Methods: Fifty HCC patients after TACE were included and underwent MRI. All of the patients were scanned with the IVIM-DWI sequence and underwent TACE retreatment within 1 week. Referring to digital subtraction angiography (DSA) and MR enhanced images, two readers measured the f, D, and D* values of the tumor active area (TAA), tumor necrotic area (TNA), and adjacent normal hepatic parenchyma (ANHP). Then, the distinctions of the TAA, TNA, and ANHP were compared and we analyzed the differential diagnosis of the parameters in three tissues. (3) Results: For values of f and D, there were significant differences between any of the TAA, TNA, and ANHP (p < 0.05). The values of f and D were the best indicators for identifying the TAA and TNA, with AUC values of 0.959 and 0.955, respectively. The values of f and D performed well for distinguishing TAA from ANHP, with AUC values of 0.835 and 0.753, respectively. (4) Conclusions: Quantitative IVIM-DWI was effective for evaluating tumor viability in HCC patients treated with TACE and may be helpful for non-invasive monitoring of the tumor viability.
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Affiliation(s)
- Xiaofei Yue
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuting Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qiqi Jiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiangjun Dong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiawei Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (J.Y.); (Q.L.); Tel.: +86-139-9561-0820 (J.Y.); +86-134-0719-3751 (Q.L.)
| | - Qian Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (J.Y.); (Q.L.); Tel.: +86-139-9561-0820 (J.Y.); +86-134-0719-3751 (Q.L.)
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Li X, Tao J, Zhu Y, Yin Z, Zhang Y, Wang S. Soft tissue sarcoma: intravoxel incoherent motion and diffusion kurtosis imaging parameters correlate with the histological grade and Ki-67 expression. Acta Radiol 2022; 64:1546-1555. [PMID: 36259287 DOI: 10.1177/02841851221131931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accurate prediction of the histological grade and Ki-67 expression of soft tissue sarcoma (STS) before surgery is essential for the subsequent diagnosis, treatment, and prognostic evaluation of patients. PURPOSE To evaluate intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in predicting the histological grade and Ki-67 expression of STS. MATERIAL AND METHODS A total of 40 patients underwent 3-T MRI, including conventional sequences; IVIM and DKI parameters were obtained. All patients were divided into a low-grade (grade 1 and grade 2) group and a high-grade (grade 3) group through pathological analysis. Ki-67 expression of each lesion was calculated. Chi-square test, independent sample t-test, Mann-Whitney U test, Pearson, Spearman, and receiver operating characteristic curve analysis were performed. RESULTS There were 17 patients in the low-grade group and 23 in the high-grade group. Ki-67 expression was in the range of 10%-80%. D value was inversely correlated with Ki-67 expression. MK value showed a moderate positive correlation with Ki-67 expression. Regarding histological grading, only the peritumoral enhancement was statistically different between low- and high-grade STS on conventional MRI (P=0.024). The high-grade group had significantly higher MK value and lower D and MD value than the low-grade group. MK value showed the best diagnostic performance. The combination of MK and MD yielded the highest specificity (88.24%), and the combination of D, MK, and MD yielded the best area under the curve value (0.841) and sensitivity (95.65%). CONCLUSION IVIM and DKI parameters were correlated with Ki-67 expression and could help differentiate between low- and high-grade STS.
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Affiliation(s)
- Xiangwen Li
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, PR China
| | - Juan Tao
- Department of Pathology, The Second Hospital, Dalian Medical University, Dalian, PR China
| | - Yifeng Zhu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, PR China
| | - Zhenzhen Yin
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, PR China
| | - Yu Zhang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, PR China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, PR China
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Zhou Y, Zheng J, Yang C, Peng J, Liu N, Yang L, Zhang XM. Application of intravoxel incoherent motion diffusion-weighted imaging in hepatocellular carcinoma. World J Gastroenterol 2022; 28:3334-3345. [PMID: 36158259 PMCID: PMC9346463 DOI: 10.3748/wjg.v28.i27.3334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/26/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
The morbidity and mortality of hepatocellular carcinoma (HCC) rank 6th and 4th, respectively, among malignant tumors worldwide. Traditional diffusion-weighted imaging (DWI) uses the apparent diffusion coefficient (ADC) obtained by applying the monoexponential model to reflect water molecule diffusion in active tissue; however, the value of ADC is affected by microcirculation perfusion. Using a biexponential model, intravoxel incoherent motion (IVIM)-DWI quantitatively measures information related to pure water molecule diffusion and microcirculation perfusion, thus compensating for the shortcomings of DWI. The number of studies examining the application of IVIM-DWI in patients with HCC has gradually increased over the last few years, and many results show that IVIM-DWI has vital value for HCC differentiation, pathological grading, and predicting and evaluating the treatment response. The present study principally reviews the principle of IVIM-DWI and its research progress in HCC differentiation, pathological grading, predicting and evaluating the treatment response, predicting postoperative recurrence and predicting gene expression prediction.
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Affiliation(s)
- Yi Zhou
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Jing Zheng
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Cui Yang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Panzhihua Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Juan Peng
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Sichuan Provincial People's Hospital Jinniu Hospital, Chengdu Jinniu District People's Hospital, Chengdu 610007, Sichuan Province, China
| | - Ning Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Medical Research Center, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Wang F, Yan CY, Wang CH, Yang Y, Zhang D. The Roles of Diffusion Kurtosis Imaging and Intravoxel Incoherent Motion Diffusion-Weighted Imaging Parameters in Preoperative Evaluation of Pathological Grades and Microvascular Invasion in Hepatocellular Carcinoma. Front Oncol 2022; 12:884854. [PMID: 35646649 PMCID: PMC9131658 DOI: 10.3389/fonc.2022.884854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
Background Currently, there are disputes about the parameters of diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and diffusion-weighted imaging (DWI) in predicting pathological grades and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). The aim of our study was to investigate and compare the predictive power of DKI and IVIM-DWI parameters for preoperative evaluation of pathological grades and MVI in HCC. Methods PubMed, Web of Science, and Embase databases were searched for relevant studies published from inception to October 2021. Review Manager 5.3 was used to summarize standardized mean differences (SMDs) of mean kurtosis (MK), mean diffusivity (MD), tissue diffusivity (D), pseudo diffusivity (D*), perfusion fraction (f), mean apparent diffusion coefficient (ADCmean), and minimum apparent diffusion coefficient (ADCmin). Stata12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC). Overall, 42 up-to-standard studies with 3,807 cases of HCC were included in the meta-analysis. Results The SMDs of ADCmean, ADCmin, and D values, but not those of D* and f values, significantly differed between well, moderately, and poorly differentiated HCC (P < 0.01). The sensitivity, specificity, and AUC of the MK, D, ADCmean, and ADCmin for preoperative prediction of poorly differentiated HCC were 69%/94%/0.89, 87%/80%/0.89, 82%/75%/0.86, and 83%/64%/0.81, respectively. In addition, the sensitivity, specificity, and AUC of the D and ADCmean for preoperative prediction of well-differentiated HCC were 87%/83%/0.92 and 82%/88%/0.90, respectively. The SMDs of ADCmean, ADCmin, D, MD, and MK values, but not f values, showed significant differences (P < 0.01) between MVI-positive (MVI+) and MVI-negative (MVI-) HCC. The sensitivity and specificity of D and ADCmean for preoperative prediction of MVI+ were 80%/80% and 74%/71%, respectively; the AUC of the D (0.87) was significantly higher than that of ADCmean (0.78) (Z = −2.208, P = 0.027). Sensitivity analysis showed that the results of the above parameters were stable and reliable, and subgroup analysis confirmed a good prediction effect. Conclusion DKI parameters (MD and MK) and IVIM-DWI parameters (D value, ADCmean, and ADCmin) can be used as a noninvasive and simple preoperative examination method to predict the grade and MVI in HCC. Compared with ADCmean and ADCmin, MD and D values have higher diagnostic efficacy in predicting the grades of HCC, and D value has superior diagnostic efficacy to ADCmean in predicting MVI+ in HCC. However, f value cannot predict the grade or MVI in HCC.
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Affiliation(s)
- Fei Wang
- Department of Medical Imaging, Luzhou People's Hospital, Luzhou, China.,Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Chun Yue Yan
- Department of Obstetrics, Luzhou People's Hospital, Luzhou, China
| | - Cai Hong Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yan Yang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Value of Intravoxel Incoherent Motion (IVIM) Imaging for Differentiation between Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1504463. [PMID: 35615729 PMCID: PMC9113914 DOI: 10.1155/2022/1504463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Efficient noninvasive imaging techniques in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) are very important because of their different management and prognosis. Our purpose was to evaluate the difference of parameters extracted from intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the two groups and their performance for the differentiation, as well as the significance of perfusion information. IVIM studies (9 b-values) in 41 patients with either ICC or HCC were reviewed retrospectively by two observers. Diffusion coefficient (D), pseudodiffusion coefficient (D∗), perfusion fraction (f), ADC, and the mean percentage of parenchymal enhancement (MPPE) at 30 s after contrast-enhancement were calculated and compared between ICC and HCC. The relationship between D∗, f values, and MPPE was evaluated by Spearman's correlation test. The diagnostic efficacy of all parameters was analyzed by the receiver operating characteristic (ROC) curve. Interobserver and intraobserver agreements were analyzed. The parameters (D and ADC) of ICC were distinctly higher than those of HCC; whereas the parameters (f and MPPE of arterial phase) were distinctly lower (all false discovery rate [FDR]-corrected P < 0.05). The metric D∗ value of ICC was slightly higher than that of HCC (71.44 vs 69.41) with FDR-corrected P > 0.05. Moreover, the value of parameter D was significantly lower than that of ADC (FDR-corrected P < 0.05). The parameters (D and f values) extracted from IVIM showed excellent diagnostic efficiency in the identification, and the diagnostic efficiency of D value was significantly higher than that of the ADC. There were positive correlations between perfusion-related parameters (D∗, f values) and MPPE. Interobserver and intraobserver agreements were excellent or perfect in measurements of all parameters. Parameters derived from IVIM were valuable for distinguishing ICC and HCC. Moreover, the D value showed better diagnostic efficiency for the differential diagnosis than monoexponential fitting-derived ADC value. Meanwhile, the significant correlation between perfusion-related parameters and MPPE demonstrates that specific IVIM metrics may serve as a noninvasive indicator for the vascular perfusion information of ICC and HCC.
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Guo Y, Chen J, Zhang Y, Guo Y, Jiang M, Dai Y, Yao X. Differentiating Cytokeratin 19 expression of hepatocellular carcinoma by using multi-b-value diffusion-weighted MR imaging with mono-exponential, stretched exponential, intravoxel incoherent motion, diffusion kurtosis imaging and fractional order calculus models. Eur J Radiol 2022; 150:110237. [DOI: 10.1016/j.ejrad.2022.110237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/02/2022] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
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Zeng P, Ma L, Liu J, Song Z, Liu J, Yuan H. The diagnostic value of intravoxel incoherent motion diffusion-weighted imaging for distinguishing nonhypervascular pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas. Eur J Radiol 2022; 150:110261. [PMID: 35316674 DOI: 10.1016/j.ejrad.2022.110261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To primarily evaluate the diagnostic performance of the monoexponential and intravoxel incoherent motion (IVIM) diffusion weighted imaging (DWI) models for differentiating between nonhypervascular pancreatic neuroendocrine tumors (PNETs) and pancreatic ductal adenocarcinomas (PDACs). METHODS 63 patients with PNETs (35 nonhypervascular PNETs and 28 hypervascular PNETs) and 164 patients with PDACs were retrospectively enrolled in the study and underwent multiple b-value DWI. Intraobserver and interobserver reliabilities of DWI parameters were assessed by using the intraclass correlation coefficient (ICC). The parameters of apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) of nonhypervascular PNETs were compared with PDACs and hypervascular PNETs using the independent sample t test or the Mann-Whitney U test. The diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. RESULTS All DWI parameters values showed good to excellent intra- and interobserver agreements (ICC = 0.743-0.873). Nonhypervascular PNETs had significantly lower ADC and D, but significantly higher f than PDACs (P = 0.005, P < 0.001 and P < 0.001, respectively). ADC, D and f of nonhypervascular PNETs were lower than hypervascular PNETs (P = 0.001, <0.001 and 0.093, respectively). D* of nonhypervascular PNETs showed no statistically significant differences with PDACs and hypervascular PNETs (P = 0.809 and 0.420). D showed a higher area under the curve (AUC), followed by ADC and f (AUC = 0.885, 0.665 and 0.740, respectively) in differentiating nonhypervascular PNETs from PDACs. CONCLUSION Monoexponential and IVIM diffusion models are valuable to differentiate nonhypervascular PNETs from PDACs. D showed better performance than f and ADC.
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Affiliation(s)
- Piaoe Zeng
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, Beijing, China
| | - Lu Ma
- Department of Radiology, Tsinghua University Hospital, 30 Shuangqing Road, Beijing 100084, Beijing, China
| | - Jianfang Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, Beijing, China
| | - Zixiu Song
- Department of Pathology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, Beijing, China
| | - Jianyu Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, Beijing, China.
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Gao F, Wei Y, Zhang T, Jiang H, Li Q, Yuan Y, Yao S, Ye Z, Wan S, Wei X, Nie L, Tang H, Song B. New Liver MR Imaging Hallmarks for Small Hepatocellular Carcinoma Screening and Diagnosing in High-Risk Patients. Front Oncol 2022; 12:812832. [PMID: 35356206 PMCID: PMC8959840 DOI: 10.3389/fonc.2022.812832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Early detection and diagnosis of hepatocellular carcinoma (HCC) is essential for prognosis; however, the imaging hallmarks for tumor detection and diagnosis has remained the same for years despite the use of many new immerging imaging methods. This study aimed to evaluate the detection performance of hepatic nodules in high risk patients using either hepatobiliary specific contrast (HBSC) agent or extracellular contrast agent (ECA), and further to compare the diagnostic performances for hepatocellular carcinoma (HCC) using different diagnostic criteria with the histopathological results as reference standard. Methods This prospective study included 247 nodules in 222 patients (mean age, 53.32 ± 10.84 years; range, 22–79 years). The detection performance and imaging features of each nodule were evaluated in all MR sequences by three experienced abdominal radiologists. The detection performance of each nodule on all MR sequences were compared and further the diagnostic performance of various diagnostic criteria were evaluated. Results For those patients who underwent ECA-MRI, the conventional imaging hallmark of “AP + PVP and/or DP” was recommended, as 60.19% diagnostic sensitivity, 80.95% specificity and 100% lesion detection rate. Additionally, for those patients who underwent HBSC-MRI, the diagnostic criteria of “DWI + HBP” was recommended. This diagnostic criteria demonstrated, both in all tumor size and for nodules ≤2 cm, higher sensitivity (93.07 and 90.16%, all p <0.05, respectively) and slightly lower specificity (64.71 and 87.50%, all p >0.05, respectively) than that of the European Association for the Study of the Liver (EASL) criteria. Conclusions Different abbreviated MR protocols were recommended for patients using either ECA or HBSC. These provided imaging settings demonstrated high lesion detection rate and diagnostic performance for HCC.
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Affiliation(s)
- Feifei Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tong Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Lisha Nie
- MR Research China, GE Healthcare, Beijing, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, Sanya People's Hospital, Sanya, China
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20
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Grussu F, Bernatowicz K, Casanova-Salas I, Castro N, Nuciforo P, Mateo J, Barba I, Perez-Lopez R. Diffusion MRI signal cumulants and hepatocyte microstructure at fixed diffusion time: Insights from simulations, 9.4T imaging, and histology. Magn Reson Med 2022; 88:365-379. [PMID: 35181943 PMCID: PMC9303340 DOI: 10.1002/mrm.29174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 11/09/2022]
Abstract
Purpose Relationships between diffusion‐weighted MRI signals and hepatocyte microstructure were investigated to inform liver diffusion MRI modeling, focusing on the following question: Can cell size and diffusivity be estimated at fixed diffusion time, realistic SNR, and negligible contribution from extracellular/extravascular water and exchange? Methods Monte Carlo simulations were performed within synthetic hepatocytes for varying cell size/diffusivity L/D0, and clinical protocols (single diffusion encoding; maximum b‐value: {1000, 1500, 2000} s/mm2; 5 unique gradient duration/separation pairs; SNR = {∞, 100, 80, 40, 20}), accounting for heterogeneity in (D0,L) and perfusion contamination. Diffusion (D) and kurtosis (K) coefficients were calculated, and relationships between (D0,L) and (D,K) were visualized. Functions mapping (D,K) to (D0,L) were computed to predict unseen (D0,L) values, tested for their ability to classify discrete cell‐size contrasts, and deployed on 9.4T ex vivo MRI‐histology data of fixed mouse livers Results Relationships between (D,K) and (D0,L) are complex and depend on the diffusion encoding. Functions mapping D,K to (D0,L) captures salient characteristics of D0(D,K) and L(D,K) dependencies. Mappings are not always accurate, but they enable just under 70% accuracy in a three‐class cell‐size classification task (for SNR = 20, bmax = 1500 s/mm2, δ = 20 ms, and Δ = 75 ms). MRI detects cell‐size contrasts in the mouse livers that are confirmed by histology, but overestimates the largest cell sizes. Conclusion Salient information about liver cell size and diffusivity may be retrieved from minimal diffusion encodings at fixed diffusion time, in experimental conditions and pathological scenarios for which extracellular, extravascular water and exchange are negligible.
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Affiliation(s)
- Francesco Grussu
- Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Kinga Bernatowicz
- Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Irene Casanova-Salas
- Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Natalia Castro
- Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joaquin Mateo
- Prostate Cancer Translational Research Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ignasi Barba
- NMR Lab, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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21
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Çelebi F, Görmez A, Serkan Ilgun A, Tokat Y, Cem Balcı N. The role of 18F- FDG PET/MRI in preoperative prediction of MVI in patients with HCC. Eur J Radiol 2022; 149:110196. [DOI: 10.1016/j.ejrad.2022.110196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
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22
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Shen H, Huang Y, Yuan X, Liu D, Tu C, Wang Y, Li X, Wang X, Chen Q, Zhang J. Using quantitative parameters derived from pretreatment dual-energy computed tomography to predict histopathologic features in head and neck squamous cell carcinoma. Quant Imaging Med Surg 2022; 12:1243-1256. [PMID: 35111620 DOI: 10.21037/qims-21-650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) patients with a high tumor grade, lymphovascular invasion (LVI), or perineural invasion (PNI) tend to demonstrate a poor prognosis in clinical series. Thus, the identification of histopathological features, including tumor grade, LVI, and PNI, before treatment could be used to stratify the prognosis of patients with HNSCC. This study aimed to assess whether quantitative parameters derived from pretreatment dual-energy computed tomography (DECT) can predict the histopathological features of patients with HNSCC. METHODS In this study, 72 consecutive patients with pathologically confirmed HNSCC were enrolled and underwent dual-phase (noncontrast-enhanced phase and contrast-enhanced phase) DECT examinations. Normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λHU), and normalized effective atomic number (NZeff) were calculated. The attenuation values on 40-140 keV noise-optimized virtual monoenergetic images [VMIs (+)] in the contrast-enhanced phase were recorded. The diagnostic performance of the quantitative parameters for predicting histopathological features, including tumor grade, LVI, and PNI, was assessed by receiver operating characteristic curves. RESULTS The NIC, λHU, NZeff, and attenuation value on the VMIs (+) at 40 keV (A40) in the grade III group, LVI-positive group, and PNI-positive group were significantly higher than those in the grade I and II groups, the LVI-negative group, and the PNI-negative group (all P values <0.05). A multivariate logistic regression model combining these 4 quantitative parameters improved the diagnostic performance of the model in predicting tumor grade, LVI, and PNI (areas under the curve: 0.969, 0.944, and 0.931, respectively). CONCLUSIONS Quantitative parameters derived from pretreatment DECT, including NIC, λHU, NZeff, and A4,0 were found to be imaging markers for predicting the histopathological characteristics of HNSCC. Combining all these characteristics improved the predictive performance of the model.
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Affiliation(s)
- Hesong Shen
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yuanying Huang
- Department of Oncology and Hematology, Chongqing General Hospital, University of the Chinese Academy of Sciences, Chongqing, China
| | - Xiaoqian Yuan
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Chunrong Tu
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yu Wang
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xiaoqin Li
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Qiuzhi Chen
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
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Kim TH, Woo S, Han S, Suh CH, Do RKG, Lee JM. Risk Factors for Hypervascularization in Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement: A Systematic Review and Meta-analysis. Acad Radiol 2022; 29:198-210. [PMID: 32962925 PMCID: PMC9115668 DOI: 10.1016/j.acra.2020.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To perform a systematic review and meta-analysis to determine risk factors for hypervascularization in hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Pubmed and EMBASE databases were searched up to May 7, 2020. Studies which evaluated radiologic and clinical risk factors for hypervascularization in HBP hypointense nodules without APHE were included. Hazard ratios were meta-analytically pooled using random-effects model. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. RESULTS Sixteen studies with 934 patients were included. HBP hypointense nodules without APHE with baseline size greater than 10 mm, T2 hyperintensity, and restricted diffusion showed risk for hypervascularization with pooled HRs of 2.95 (95% confidence interval [CI], 1.94-4.20), 4.21 (95% CI, 1.15-15.40), 5.83 (95% CI, 1.42-23.95), respectively. Previous HCC history contributed to hypervascularization of the nodules with hazard ratio of 2.06 (95% CI, 1.23-3.44). T1 hyperintensity, intralesional fat, Child-Pugh Class B, sex, alfa-fetoprotein, hepatitis B or C infection were not significant risk factors for hypervascularization (p ≥0.05). Study quality was generally moderate. CONCLUSION HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI with baseline size greater than 10 mm, T2 hyperintensity, restricted diffusion and previous hepatocellular carcinoma history pose higher risk for hypervascularization. Proper patient management in patients with HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI may need to be tailored according to these risk factors.
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Perfusion-Diffusion Ratio: A New IVIM Approach in Differentiating Solid Benign and Malignant Primary Lesions of the Liver. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2957759. [PMID: 35075424 PMCID: PMC8783718 DOI: 10.1155/2022/2957759] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Introduction In order to improve the efficacy of intravoxel incoherent motion (IVIM) parameters in characterising specific tissues, a new concept is introduced: the perfusion–diffusion ratio (PDR), which expresses the relationship between the signal S(b) decline rate as a result of IVIM and the rate of signal S(b) decline due to diffusion. The aim of this study was to investigate this novel approach in the differentiation of solid primary liver lesions. Material and Methods. Eighty-three patients referred for liver MRI between August 2017 and January 2020 with a suspected liver tumour were prospectively examined with the standard liver MRI protocol extended by DWI-IVIM sequence. Patients with no liver lesions, haemangiomas, or metastases were excluded. The final study population consisted of 34 patients with primary solid liver masses, 9 with FNH, 4 with regenerative nodules, 10 with HCC, and 11 with CCC. The PDR coefficient was introduced, defined as the ratio of the rate of signal S(b) decrease due to the IVIM effect to the rate of signal S(b) decrease due to the diffusion process, for b = 0. Results No significant differences were found between benign and malignant lesions in the case of IVIM parameters (f, D, or D∗) and ADC. Significant differences were observed only for PDR, with lower values for malignant lesions (p = 0.03). The ROC analysis yielded an AUC value for PDR equal to 0.74, with a cut-off value of 5.06, sensitivity of 81%, specificity of 77%, and accuracy of 79%. Conclusion PDR proved to be more effective than IVIM parameters and ADC in the differentiation of solid benign and malignant primary liver lesions.
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25
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Andersson M, Jalnefjord O, Montelius M, Rizell M, Sternby Eilard M, Ljungberg M. Evaluation of response in patients with hepatocellular carcinoma treated with intratumoral dendritic cell vaccination using intravoxel incoherent motion (IVIM) MRI and histogram analysis. Acta Radiol 2021; 64:32-41. [PMID: 34904868 DOI: 10.1177/02841851211065935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Immunotherapy of hepatocellular carcinoma (HCC) is an emerging method with promising results. Immunotherapy can have an antitumor effect without affecting tumor size, calling for functional imaging methods for response evaluation. PURPOSE To evaluate the response to intratumoral injections with the immune primer ilixadencel in HCCs with diffusion-weighted magnetic resonance imaging (DW-MRI) using intravoxel incoherent motion (IVIM) and histogram analysis. MATERIAL AND METHODS A total of 17 patients with advanced HCC were treated with intratumoral injections with ilixadencel on three occasions 2-5 weeks apart. The patients were examined with IVIM before each injection as well as approximately three months after the first injection. RESULTS The 10th percentile of perfusion-related parameter D* decreased significantly after the first and second intratumoral injections of ilixadencel compared to baseline (P < 0.05). There was a non-significant trend of lower median region of interest f (perfusion fraction) before injection 2 compared to baseline (P = 0.07). There were significant correlations between the 10th percentile and median of D at baseline and change in tumor size after three months (r = 0.79, P < 0.01 and r = 0.72, P < 0.05, respectively). CONCLUSION DW-MRI with IVIM and histogram analysis revealed significant reductions of D* early after treatment as well as an association between D at baseline and smaller tumor growth at three months. The lower percentiles (10th and 50th) were found more important. Further research is needed to confirm our preliminary findings of reduced perfusion after ilixadencel vaccinations, suggesting a treatment effect on HCC.
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Affiliation(s)
- Mats Andersson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Oscar Jalnefjord
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Montelius
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Sternby Eilard
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ljungberg
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wang C, Dong H. Intravoxel incoherent motion magnetic resonance imaging in predicting IDH1 gene mutations in high-grade gliomas. Acta Radiol 2021; 62:1412-1417. [PMID: 33951927 DOI: 10.1177/02841851211011914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) has been applied to gliomas; however, the relationships between its parameters and isocitrate dehydrogenase 1 (IDH1) mutations in gliomas remain to be investigated. PURPOSE To investigate the value of IVIM in predicting IDH1 mutations in high-grade gliomas before surgery. MATERIAL AND METHODS A total of 72 patients with pathologically confirmed high-grade gliomas underwent conventional brain MRI and IVIM from September 2016 to May 2020. Among them, 22 cases were IDH1 mutant and 50 cases were IDH1 wild type. The independent samples t test (normal distribution and homogeneity of variance) or Mann-Whitney rank-sum test (non-normal distribution or heterogeneity of variance) was conducted, and receiver operating characteristic curves were generated to determine parameters for distinguishing IDH1-mutated from IDH1 wild-type high-grade gliomas. These parameters included apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f). RESULTS ADC, D, and f were significantly higher in IDH1-mutated gliomas than in IDH1 wild-type gliomas (P < 0.05 for all). There was no significant difference in the D* value between the two groups (P = 0.053). The areas under the curve of ADC, D, and f in predicting IDH1 mutations in gliomas were 0.798, 0.810, and 0.823, respectively. The specificity of ADC was highest (80.0%), and the sensitivity of the f value was the highest (100.0%). CONCLUSION IVIM can be used for the quantitative prediction of IDH1 mutations in high-grade gliomas before surgery, and the f value is the most effective.
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Affiliation(s)
- Chaochao Wang
- Department of Radiology, Lihuili Hospital of Ningbo Medical Center, Ningbo, Zhejiang, PR China
| | - Haibo Dong
- Department of Radiology, Lihuili Hospital of Ningbo Medical Center, Ningbo, Zhejiang, PR China
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Zeng Q, Liu B, Xu Y, Zhou W. An attention-based deep learning model for predicting microvascular invasion of hepatocellular carcinoma using an intra-voxel incoherent motion model of diffusion-weighted magnetic resonance imaging. Phys Med Biol 2021; 66. [PMID: 34469880 DOI: 10.1088/1361-6560/ac22db] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/01/2021] [Indexed: 12/13/2022]
Abstract
The intra-voxel incoherent motion model of diffusion-weighted magnetic resonance imaging (IVIM-DWI) with a series of images with differentb-values has great potential as a tool for detecting, diagnosing, staging, and monitoring disease progression or the response to treatment. The current clinical tumour characterisation using IVIM-DWI is based on the parameter values derived from the IVIM model. On the one hand, the calculation accuracy of such parameter values is susceptible to deviations due to noise and motion; on the other hand, the performance of the parameter values is rather limited with respect to tumour characterisation. In this article, we propose a deep learning approach to directly extract spatiotemporal features from a series ofb-value images of IVIM-DWI using a deep learning network for lesion characterisation. Specifically, we introduce an attention mechanism to select dominant features from specificb-values, channels, and spatial areas of the multipleb-value images for better lesion characterisation. The experimental results for clinical hepatocellular carcinoma (HCC) when using IVIM-DWI demonstrate the superiority of the proposed deep learning model for predicting the microvascular invasion (MVI) of HCC. In addition, the ablation study reflects the effectiveness of the attention mechanism for improving MVI prediction. We believe that the proposed model may be a useful tool for the lesion characterisation of IVIM-DWI in clinical practice.
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Affiliation(s)
- Qingyuan Zeng
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, People's Republic of China
| | - Baoer Liu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Wu Zhou
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, People's Republic of China
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Jing M, Cao Y, Zhang P, Zhang B, Lin X, Deng L, Han T, Zhou J. The Benefit of Apparent Diffusion Coefficient in Evaluating the Invasiveness of Hepatocellular Carcinoma. Front Oncol 2021; 11:719480. [PMID: 34504795 PMCID: PMC8423087 DOI: 10.3389/fonc.2021.719480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate hepatocellular carcinoma (HCC) invasiveness using the apparent diffusion coefficient (ADC). Methods Eighty-one patients with HCC confirmed by pathology and examined by preoperative magnetic resonance imaging diffusion-weighted imaging from January 2015 to September 2020 were retrospectively analyzed. Clinical and pathological data were recorded. The minimum ADC (ADCmin), average ADC (ADCmean), and the ratio of ADCmean to normal-appearing hepatic parenchyma ADC (ADCnahp) were assessed. The associations between clinical information, ADC value, and HCC invasiveness (microvascular invasion [MVI], tumor differentiation, and Ki-67 expression) were evaluated statistically. Independent risk factors related to HCC invasiveness were screened using binary logistic regression, and the diagnostic efficiency was evaluated by the receiver operating characteristic curve and its area under the curve (AUC) value. Results Tumor size was related to HCC MVI and tumor differentiation (P < 0.05). HCC MVI was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.860, 0.860, and 0.909, respectively. If these were combined with tumor size, the AUC value increased to 0.912. The degree of tumor differentiation was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.719, 0.708, and 0.797, respectively. If these were combined with tumor size, the AUC value increased to 0.868. Ki-67 expression was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.731, 0.747, and 0.746, respectively. Combined them, the AUC value increased to 0.763. Conclusions The findings indicated that the ADC value has significant potential for the non-invasive preoperative evaluation of HCC invasiveness.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Yuntai Cao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Affiliated Hospital of Qinghai University, Xining, China
| | - Peng Zhang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Xiaoqiang Lin
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
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Comparison of Diagnostic Performance between Perfusion-Related Intravoxel Incoherent Motion DWI and Dynamic Contrast-Enhanced MRI in Rectal Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5095940. [PMID: 34367318 PMCID: PMC8346302 DOI: 10.1155/2021/5095940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
This study was aimed to determine the diagnostic performance of perfusion-related parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) by comparing them with quantitative parameters from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on differentiation grades of rectal cancer. We retrospectively analyzed 98 patients with rectal cancer. Perfusion-related IVIM parameters (D∗, f, and f·D∗) and quantitative DCE parameters (Ktrans, Kep, Ve, and Vp) were obtained by plotting the volume-of-interest on in-house software. Furthermore, we compared the difference and diagnostic performance of all well-moderately and poorly differentiated rectal cancer parameters. Finally, we analyzed the correlation between those DCE and IVIM parameters and pathological differentiation grade. The values of f, Ktrans, and Kep significantly differentiated poor and well-moderate rectal cancers. Ktrans achieved the highest area under the curve (AUC) value compared to perfusion-related IVIM and DCE parameters. Furthermore, Ktrans showed a better correlation with pathological differentiation grade than f. The diagnostic efficiency of DCE-MRI was greater than perfusion-related IVIM parameters. The f value derived from perfusion-related IVIM offered a diagnostic performance similar to DCE-MRI for patients with renal insufficiency.
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Dynamic Contrast-Enhanced and Intravoxel Incoherent Motion MRI Biomarkers Are Correlated to Survival Outcome in Advanced Hepatocellular Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11081340. [PMID: 34441274 PMCID: PMC8391260 DOI: 10.3390/diagnostics11081340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: This study assessed dynamic contrast-enhanced (DCE)-MRI and intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI) parameters to prospectively predict survival outcomes in participants with advanced hepatocellular carcinoma (HCC) who received lenalidomide, a dual antiangiogenic and immunomodulatory agent, as second-line therapy in a Phase II clinical trial. Materials and methods: Forty-four participants with advanced HCC who had progression after sorafenib as first-line treatment were prospectively enrolled. Pretreatment MRI parameters—obtained from DCE-MRI (peak, slope, AUC, Ktrans, Kep, and Ve), apparent diffusion coefficient (ADC), and IVIM DWI (pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f))—were derived from the largest hepatic tumor. The Cox model was used to investigate the associations of the parameters with progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS were 2.3 and 8.0 months, respectively. Univariate analysis showed that participants with a high slope (p = 0.024), Kep (p < 0.001), and ADC (p = 0.018) values had longer PFS than those with low values; participants with a small tumor size (p = 0.006), high slope (p = 0.01), ADC (p = 0.015), and f (p = 0.012) values had longer OS than those with low values did. Cox multivariable analysis revealed that Kep (p < 0.001) and ADC (p = 0.009) remained independent predictors of PFS; slope (p = 0.003) and ADC (p = 0.009) remained independent predictors of OS. Moreover, Kep and slope were still significant after Bonferroni correction was performed (p < 0.005). Conclusion: Both pretreatment DCE-MRI and IVIM DWI parameters, especially slope and ADC, may predict PFS and OS in participants with HCC receiving lenalidomide as second-line therapy.
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The Role of Non-Gaussian Models of Diffusion Weighted MRI in Hepatocellular Carcinoma: A Systematic Review. J Clin Med 2021; 10:jcm10122641. [PMID: 34203995 PMCID: PMC8232758 DOI: 10.3390/jcm10122641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
The importance of Diffusion Weighted Imaging (DWI) in hepatocellular carcinoma (HCC) has been widely handled in the literature. Due to the mono-exponential model limitations, several studies recently investigated the role of non-Gaussian DWI models in HCC. However, their results are variable and inconsistent. Therefore, the aim of this systematic review is to summarize current knowledge on non-Gaussian DWI techniques in HCC. A systematic search of the literature, including PubMed, Google Scholar, MEDLINE, and ScienceDirect databases, was performed to identify original articles since 2010 that evaluated the role of non-Gaussian DWI models for HCC diagnosis, grading, response to treatment, and prognosis. Studies were grouped and summarized according to the non-Gaussian DWI models investigated. We focused on the most used non-Gaussian DWI models (Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Stretched Exponential—SE). The quality of included studies was evaluated by using QUADAS-2 and QUIPS tools. Forty-three articles were included, with IVIM and DKI being the most investigated models. Although the role of non-Gaussian DWI models in clinical settings has not fully been established, our findings showed that their parameters may potentially play a role in HCC. Further studies are required to identify a standardized DWI acquisition protocol for HCC diagnosis, grading, response to treatment, and prognosis.
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Song Q, Guo Y, Yao X, Rao S, Qian C, Ye D, Zeng M. Comparative study of evaluating the microcirculatory function status of primary small HCC between the CE (DCE-MRI) and Non-CE (IVIM-DWI) MR Perfusion Imaging. Abdom Radiol (NY) 2021; 46:2575-2583. [PMID: 33483778 DOI: 10.1007/s00261-020-02945-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/20/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the difference of evaluating the microcirculatory function status of primary small HCC between DCE-MRI with two-compartmental pharmacokinetic model and IVIM-DWI. METHODS 27 patients (22 men, 5 women; mean age, 49 years; range 36-65 years) with primary single sHCC who underwent IVIM-DWI and DCE-MRI before the operation were included in this retrospective study. The MR perfusion parameters are Ktrans, Ve, Kep, D, D* and f. Pathological results include pathological grade (low grade ≤ II, high grade > II) and MVD. The perfusion parameters and pathological results of sHCC were analyzed and compared in their relevance, sensitivity and specificity. Statistical methods included Spearman and ROC curve analysis. RESULTS The perfusion parameters (Ktrans, Kep, D*, f) were significantly positive correlated (r = 0.892, 0.808, 0.589 and 0.543, P = 0.000, 0.000, 0.001 and 0.003 with MVD of sHCC. The parameter Ve and D values were negatively correlated (r = - 0.454 and - 0.399, P = 0.017 and 0.039, respectively) with the pathological grade. Regarding the evaluation MVD of sHCC, the evaluation of the sensitivity and specificity performance was present in descending order: Ktrans > Kep > PF > D*. In the evaluation pathological grade of sHCC, the sensitivity and specificity were better by parameters D than Ve. CONCLUSION DCE-MRI is better than IVIM-DWI for evaluation microcirculation functional status of sHCC. But for evaluating the pathological grade, IVIM-DWI is better than DCE-MRI. Combination of the two imaging techniques may provide more comprehensive evaluation in microcirculation functional status of the sHCC.
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Affiliation(s)
- Qiong Song
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
- Radiology Department, Xuzhou Mining Group General Hospital, Xuzhou, 221000, Jiangsu, People's Republic of China
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Yixian Guo
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Xiuzhong Yao
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Chengyao Qian
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Dexian Ye
- Shanghai Aitrox Technology Corporation Limited, Shanghai, 200032, People's Republic of China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital of Fudan University, Fudan University, Shanghai Institute of Medical Imaging, No 130, Dongan Rd, Xuhui District, Shanghai, 200032, People's Republic of China.
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A study of the correlations between IVIM-DWI parameters and the histologic differentiation of hepatocellular carcinoma. Sci Rep 2021. [PMID: 34001962 DOI: 10.1038/s41598-021-89784-2.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The present study aimed to investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in the preoperative prediction of the histologic differentiation of hepatocellular carcinoma (HCC). Seventy HCC patients were scanned with a 3.0 T magnetic resonance scanner. The values of apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (D), fast apparent diffusion coefficient (D*), and the fraction of the fast apparent diffusion coefficient (f) were measured. Analysis of variance was used to compare the differences in parameters between groups with different degrees of histologic differentiation. p < 0.05 was considered statistically significant. Receiver operating characteristic (ROC) curves were used to analyse the efficacy of IVIM-DWI parameters for predicting the histologic differentiation of HCC. The ADC and D values for well, moderately and poorly differentiated HCC were 1.35 ± 0.17 × 10-3 mm2/s, 1.16 ± 0.17 × 10-3 mm2/s, 0.98 ± 0.21 × 10-3 mm2/s, and 1.06 ± 0.15 × 10-3 mm2/s, 0.88 ± 0.16 × 10-3 mm2/s, 0.76 ± 0.18 × 10-3 mm2/s, respectively, and all differences were significant. The D* and f values of the three groups were 32.87 ± 14.70 × 10-3 mm2/s, 41.68 ± 17.90 × 10-3 mm2/s, 34.54 ± 18.60 × 10-3 mm2/s and 0.22 ± 0.07, 0.23 ± 0.08, 0.18 ± 0.07, respectively, with no significant difference. When the cut-off values of ADC and D were 1.25 × 10-3 mm2/s and 0.97 × 10-3 mm2/s, respectively, their diagnostic sensitivities and specificities for distinguishing well differentiated HCC from moderately differentiated and poorly differentiated HCC were 73.3%, 85.5%, 86.7%, and 78.2%, and their areas under the ROC curve were 0.821 and 0.841, respectively. ADC and D values can be used preoperatively to predict the degree of histologic differentiation in HCC, and the D value has better diagnostic value.
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Zhou Y, Yang G, Gong XQ, Tao YY, Wang R, Zheng J, Yang C, Peng J, Yang L, Li JD, Zhang XM. A study of the correlations between IVIM-DWI parameters and the histologic differentiation of hepatocellular carcinoma. Sci Rep 2021; 11:10392. [PMID: 34001962 PMCID: PMC8129092 DOI: 10.1038/s41598-021-89784-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in the preoperative prediction of the histologic differentiation of hepatocellular carcinoma (HCC). Seventy HCC patients were scanned with a 3.0 T magnetic resonance scanner. The values of apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (D), fast apparent diffusion coefficient (D*), and the fraction of the fast apparent diffusion coefficient (f) were measured. Analysis of variance was used to compare the differences in parameters between groups with different degrees of histologic differentiation. p < 0.05 was considered statistically significant. Receiver operating characteristic (ROC) curves were used to analyse the efficacy of IVIM-DWI parameters for predicting the histologic differentiation of HCC. The ADC and D values for well, moderately and poorly differentiated HCC were 1.35 ± 0.17 × 10−3 mm2/s, 1.16 ± 0.17 × 10−3 mm2/s, 0.98 ± 0.21 × 10−3 mm2/s, and 1.06 ± 0.15 × 10−3 mm2/s, 0.88 ± 0.16 × 10−3 mm2/s, 0.76 ± 0.18 × 10−3 mm2/s, respectively, and all differences were significant. The D* and f values of the three groups were 32.87 ± 14.70 × 10−3 mm2/s, 41.68 ± 17.90 × 10−3 mm2/s, 34.54 ± 18.60 × 10−3 mm2/s and 0.22 ± 0.07, 0.23 ± 0.08, 0.18 ± 0.07, respectively, with no significant difference. When the cut-off values of ADC and D were 1.25 × 10−3 mm2/s and 0.97 × 10−3 mm2/s, respectively, their diagnostic sensitivities and specificities for distinguishing well differentiated HCC from moderately differentiated and poorly differentiated HCC were 73.3%, 85.5%, 86.7%, and 78.2%, and their areas under the ROC curve were 0.821 and 0.841, respectively. ADC and D values can be used preoperatively to predict the degree of histologic differentiation in HCC, and the D value has better diagnostic value.
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Affiliation(s)
- Yi Zhou
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China.,Department of Radiology, People's Hospital of Deyang City, Deyang, 618000, Sichuan, People's Republic of China
| | - Gang Yang
- Institute of Hepato-Biliary-Intestinal Disease, Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Xue-Qin Gong
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yun-Yun Tao
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Ran Wang
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jing Zheng
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Cui Yang
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Juan Peng
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China.
| | - Jing-Dong Li
- Institute of Hepato-Biliary-Intestinal Disease, Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Medical Research Center, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China
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Cannella R, Sartoris R, Grégory J, Garzelli L, Vilgrain V, Ronot M, Dioguardi Burgio M. Quantitative magnetic resonance imaging for focal liver lesions: bridging the gap between research and clinical practice. Br J Radiol 2021; 94:20210220. [PMID: 33989042 PMCID: PMC8173689 DOI: 10.1259/bjr.20210220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) is highly important for the detection, characterization, and follow-up of focal liver lesions. Several quantitative MRI-based methods have been proposed in addition to qualitative imaging interpretation to improve the diagnostic work-up and prognostics in patients with focal liver lesions. This includes DWI with apparent diffusion coefficient measurements, intravoxel incoherent motion, perfusion imaging, MR elastography, and radiomics. Multiple research studies have reported promising results with quantitative MRI methods in various clinical settings. Nevertheless, applications in everyday clinical practice are limited. This review describes the basic principles of quantitative MRI-based techniques and discusses the main current applications and limitations for the assessment of focal liver lesions.
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Affiliation(s)
- Roberto Cannella
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.,Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | | | - Jules Grégory
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Lorenzo Garzelli
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,INSERM U1149, CRI, Paris, France
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Ma M, Liang J, Zhang D, Xu X, Cheng Q, Xiao Z, Shi C, Luo L. Monitoring Treatment Efficacy of Antiangiogenic Therapy Combined With Hypoxia-Activated Prodrugs Online Using Functional MRI. Front Oncol 2021; 11:672047. [PMID: 33996599 PMCID: PMC8120295 DOI: 10.3389/fonc.2021.672047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023] Open
Abstract
Objective This study aimed to investigate the effectiveness of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) in monitoring tumor responses to antiangiogenic therapy combined with hypoxia-activated prodrugs (HAPs). Materials and methods Establishing colon cancer xenograft model by subcutaneously injecting the HCT116 cell line into BALB/C nude mice. Twenty-four tumor-bearing mice were randomly divided into four groups and injected with bevacizumab combined with TH-302 (A), bevacizumab (B), TH-302 (C), or saline (D) on days 1, 4, 7, 10 and 13. Functional MRI was performed before and at 3, 6, 9, 12 and 15 days after treatment. Pathologic examinations, including HE staining, HIF-1α and CD31 immunohistochemical staining, and TUNEL and Ki-67 immunofluorescent staining, were performed after the last scan. Results At the end of the study, Group A showed the lowest tumor volume, followed by Groups B, C, and D (F=120.652, P<0.001). For pathologic examinations, Group A showed the lowest percentage of CD31 staining (F=73.211, P<0.001) and Ki-67 staining (F=231.170, P<0.001), as well as the highest percentage of TUNEL staining (F=74.012, P<0.001). Moreover, the D* and f values exhibited positive correlations with CD31 (r=0.868, P<0.001, and r=0.698, P=0.012, respectively). R2* values was positively correlated with HIF-1α (r=0.776, P=0.003). D values were positively correlated with TUNEL (r=0.737, P=0.006) and negatively correlated with Ki-67 (r=0.912, P<0.001). The standard ADC values were positive correlated with TUNEL (r=0.672, P=0.017) and negative correlated with Ki-67 (r=0.873, P<0.001). Conclusion Anti-angiogenic agents combined with HAP can inhibit tumor growth effectively. In addition, IVIM-DWI and BOLD-MRI can be used to monitor the tumor microenvironment, including perfusion, hypoxia, cell apoptosis and proliferation, in a noninvasive manner.
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Affiliation(s)
- Mengjie Ma
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianye Liang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xi Xu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qingqing Cheng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zeyu Xiao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Li S, Zheng Y, Sun W, Lasič S, Szczepankiewicz F, Wei Q, Han S, Zhang S, Zhong X, Wang L, Li H, Cai Y, Xu D, Li Z, He Q, van Westen D, Bryskhe K, Topgaard D, Xu H. Glioma grading, molecular feature classification, and microstructural characterization using MR diffusional variance decomposition (DIVIDE) imaging. Eur Radiol 2021; 31:8197-8207. [PMID: 33914116 DOI: 10.1007/s00330-021-07959-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the potential of diffusional variance decomposition (DIVIDE) for grading, molecular feature classification, and microstructural characterization of gliomas. MATERIALS AND METHODS Participants with suspected gliomas underwent DIVIDE imaging, yielding parameter maps of fractional anisotropy (FA), mean diffusivity (MD), anisotropic mean kurtosis (MKA), isotropic mean kurtosis (MKI), total mean kurtosis (MKT), MKA/MKT, and microscopic fractional anisotropy (μFA). Tumor type and grade, isocitrate dehydrogenase (IDH) 1/2 mutant status, and the Ki-67 labeling index (Ki-67 LI) were determined after surgery. Statistical analysis included 33 high-grade gliomas (HGG) and 17 low-grade gliomas (LGG). Tumor diffusion metrics were compared between HGG and LGG, among grades, and between wild and mutated IDH types using appropriate tests according to normality assessment results. Receiver operating characteristic and Spearman correlation analysis were also used for statistical evaluations. RESULTS FA, MD, MKA, MKI, MKT, μFA, and MKA/MKT differed between HGG and LGG (FA: p = 0.047; MD: p = 0.037, others p < 0.001), and among glioma grade II, III, and IV (FA: p = 0.048; MD: p = 0.038, others p < 0.001). All diffusion metrics differed between wild-type and mutated IDH tumors (MKI: p = 0.003; others: p < 0.001). The metrics that best discriminated between HGG and LGGs and between wild-type and mutated IDH tumors were MKT and FA respectively (area under the curve 0.866 and 0.881). All diffusion metrics except FA showed significant correlation with Ki-67 LI, and MKI had the highest correlation coefficient (rs = 0.618). CONCLUSION DIVIDE is a promising technique for glioma characterization and diagnosis. KEY POINTS • DIVIDE metrics MKI is related to cell density heterogeneity while MKA and μFA are related to cell eccentricity. • DIVIDE metrics can effectively differentiate LGG from HGG and IDH mutation from wild-type tumor, and showed significant correlation with the Ki-67 labeling index. • MKI was larger than MKA which indicates predominant cell density heterogeneity in gliomas. • MKA and MKI increased with grade or degree of malignancy, however with a relatively larger increase in the cell eccentricity metric MKA in relation to the cell density heterogeneity metric MKI.
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Affiliation(s)
- Sirui Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | | | - Wenbo Sun
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | | | | | - Qing Wei
- United Imaging Healthcare, Shanghai, China
| | | | | | - Xiaoli Zhong
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Liang Wang
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Huan Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yuxiang Cai
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Dan Xu
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Zhiqiang Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Qiang He
- United Imaging Healthcare, Shanghai, China
| | | | | | | | - Haibo Xu
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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Surov A, Pech M, Omari J, Fischbach F, Damm R, Fischbach K, Powerski M, Relja B, Wienke A. Diffusion-Weighted Imaging Reflects Tumor Grading and Microvascular Invasion in Hepatocellular Carcinoma. Liver Cancer 2021; 10:10-24. [PMID: 33708636 PMCID: PMC7923880 DOI: 10.1159/000511384] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To date, there are inconsistent data about relationships between diffusion-weighted imaging (DWI) and tumor grading/microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Our purpose was to systematize the reported results regarding the role of DWI in prediction of tumor grading/MVI in HCC. METHOD MEDLINE library, Scopus, and Embase data bases were screened up to December 2019. Overall, 29 studies with 2,715 tumors were included into the analysis. There were 20 studies regarding DWI and tumor grading, 8 studies about DWI and MVI, and 1 study investigated DWI, tumor grading, and MVI in HCC. RESULTS In 21 studies (1,799 tumors), mean apparent diffusion coefficient (ADC) values (ADCmean) were used for distinguishing HCCs. ADCmean of G1-3 lesions overlapped significantly. In 4 studies (461 lesions), minimum ADC (ADCmin) was used. ADCmin values in G1/2 lesions were over 0.80 × 10-3 mm2/s and in G3 tumors below 0.80 × 10-3 mm2/s. In 4 studies (241 tumors), true diffusion (D) was reported. A significant overlapping of D values between G1, G2, and G3 groups was found. ADCmean and MVI were analyzed in 9 studies (1,059 HCCs). ADCmean values of MIV+/MVI- lesions overlapped significantly. ADCmin was used in 4 studies (672 lesions). ADCmin values of MVI+ tumors were in the area under 1.00 × 10-3 mm2/s. In 3 studies (227 tumors), D was used. Also, D values of MVI+ lesions were predominantly in the area under 1.00 × 10-3 mm2/s. CONCLUSION ADCmin reflects tumor grading, and ADCmin and D predict MVI in HCC. Therefore, these DWI parameters should be estimated for every HCC lesion for pretreatment tumor stratification. ADCmean cannot predict tumor grading/MVI in HCC.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany,*Alexey Surov, Department of Radiology and Nuclear Medicine, Ott-Von-Guericke University Magdeburg, Leipziger St., 44, DE–39112 Magdeburg (Germany),
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Borna Relja
- Department of Radiology and Nuclear Medicine University of Magdeburg, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Feasibility of intravoxel incoherent motion diffusion-weighted imaging in distinguishing adenocarcinoma originated from uterine corpus or cervix. Abdom Radiol (NY) 2021; 46:732-744. [PMID: 32671441 DOI: 10.1007/s00261-020-02586-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively assess the incremental value of intravoxel incoherent motion (IVIM) DWI in determining whether the adenocarcinoma originated from the uterine corpus or cervix. METHODS Eighty consecutive uterine adenocarcinomas from the cervix or endometrium confirmed by histopathology underwent IVIM DWI acquisition on a 3.0T MR scanner before treatment. Five morphologic features were analyzed using Fisher exact test; IVIM DWI-derived parameters, including apparent diffusion coefficient (ADC), true coefficient diffusivity (D), perfusion-related diffusivity (D*), and perfusion fraction (f) were compared using two-sample independent t-test or Mann-Whitney U test. Logistic regression analysis was used to develop different diagnosis model. The ROCs of these variables and diagnostic models were compared to evaluate the diagnostic efficiency. RESULTS Among single morphologic features, tumor location yielded the highest AUC of 0.891 in distinguishing endometrial adenocarcinoma (EAC) from cervical adenocarcinoma (CAC). Among single IVIM DWI-derived parameters, f values showed the best diagnostic performance (AUC: 0.837) at the optimal cut-off value of 0.261. Additionally, the combined diagnostic model, which consisted of tumor location, ADC and f showed the largest AUC of 0.967 with the highest sensitivity of 88.14%, highest specificity of 100.00%, and highest accuracy of 91.25%. CONCLUSION IVIM DWI-derived parameters add additional diagnostic value to conventional morphologic features. A combined diagnosis model is a promising imaging tool for predicting the origin of uterine adenocarcinoma, further contributing to therapeutic decision-making.
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Wu B, Jia F, Li X, Li L, Wang K, Han D. Comparative Study of Amide Proton Transfer Imaging and Intravoxel Incoherent Motion Imaging for Predicting Histologic Grade of Hepatocellular Carcinoma. Front Oncol 2020; 10:562049. [PMID: 33194630 PMCID: PMC7659984 DOI: 10.3389/fonc.2020.562049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/18/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Preoperative grading of hepatocellular carcinoma (HCC) is an important factor associated with prognosis after liver resection. The promising prediction of the differentiation of HCC remains a challenge. The purpose of our study was to investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of HCC, compared with the intravoxel incoherent motion (IVIM) imaging. Methods: From September 2018 to February 2020, 88 patients with HCC were enrolled and divided into four groups (G1, G2, G3, and G4) based on the histologic grades. Preoperative APT signal intensity (SI), apparent diffusion coefficient (ADC), true molecular diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f ) of HCC were independently measured by two radiologists. The averaged values of those parameters were compared using an analysis of variance. The Spearman rank analysis was used to compare the correlation between those imaging parameters and the histological grades. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance. Results: There were significant differences in APT SI, ADC, D, and f among the four grades of HCC (all P < 0.001). A moderate to good relationship was found between APT SI and the histologic grade of HCC (r = 0.679, P < 0.001). APT SI had an area under the ROC curve (AUC) of 0.890 (95% CI: 0.805–0.947) for differentiating low- from high-grade HCC, and the corresponding sensitivity and specificity were 85.71% and 82.05%, respectively. Comparison of ROC curves demonstrated that the AUC of APT SI was significantly higher than those of IVIM-derived parameter (Z = 2.603, P = 0.0092; Z = 2.099, P = 0.0358; Z = 4.023, P = 0.0001; Z = 2.435, P = 0.0149, compared with ADC, D, D*, and f , respectively). Moreover, the combination of both techniques further improved the diagnostic performance, with an AUC of 0.929 (95% CI: 0.854–0.973). Conclusion: APT imaging may be a potential noninvasive biomarker for the prediction of histologic grading of HCC and complements IVIM imaging for the more accurate and comprehensive characterization of HCC.
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Affiliation(s)
- Baolin Wu
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.,Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Fei Jia
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xuekun Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Lei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, China
| | - Dongming Han
- Department of Magnetic Resonance, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Preoperatively Grading Rectal Cancer with the Combination of Intravoxel Incoherent Motions Imaging and Diffusion Kurtosis Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:2164509. [PMID: 33100931 PMCID: PMC7576354 DOI: 10.1155/2020/2164509] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
Purpose To combine Intravoxel Incoherent Motions (IVIM) imaging and diffusion kurtosis imaging (DKI) which can aid in the quantification of different biological inspirations including cellularity, vascularity, and microstructural heterogeneity to preoperatively grade rectal cancer. Methods A total of 58 rectal patients were included into this prospective study. MRI was performed with a 3T scanner. Different combinations of IVIM-derived and DKI-derived parameters were performed to grade rectal cancer. Pearson correlation coefficients were applied to evaluate the correlations. Binary logistic regression models were established via integrating different DWI parameters for screening the most sensitive parameter. Receiver operating characteristic analysis was performed for evaluating the diagnostic performance. Results For individual DWI-derived parameters, all parameters except the pseudodiffusion coefficient displayed the capability of grading rectal cancer (p < 0.05). The better discrimination between high- and low-grade rectal cancer was achieved with the combination of different DWI-derived parameters. Similarly, ROC analysis suggested the combination of D (true diffusion coefficient), f (perfusion fraction), and Kapp (apparent kurtosis coefficient) yielded the best diagnostic performance (AUC = 0.953, p < 0.001). According to the result of binary logistic analysis, cellularity-related D was the most sensitive predictor (odds ratio: 9.350 ± 2.239) for grading rectal cancer. Conclusion The combination of IVIM and DKI holds great potential in accurately grading rectal cancer as IVIM and DKI can provide the quantification of different biological inspirations including cellularity, vascularity, and microstructural heterogeneity.
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Wu B, Jia F, Li X, Zhang M, Han D, Jia Z. Amide Proton Transfer Imaging vs Diffusion Kurtosis Imaging for Predicting Histological Grade of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2020; 7:159-168. [PMID: 33117750 PMCID: PMC7555354 DOI: 10.2147/jhc.s272535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of hepatocellular carcinoma (HCC), compared with diffusion kurtosis imaging (DKI). Methods A total of 88 patients with HCC were enrolled and divided into four groups (G1, G2, G3, and G4) based on histologic grades. Preoperative APT signal intensity (SI), mean diffusivity (MD), mean kurtosis (MK) of HCC were measured and compared. Those quantitative magnetic resonance imaging (qMRI) parameters were compared using an analysis of variance. The correlations between the qMRI parameters and the histological grades were determined using Spearman's rank analysis. In addition, the predictive performance for differentiating low- (G1 and G2) from high-grade (G3 and G4) HCC was evaluated using receiver operating characteristic (ROC) curve analysis. Results Significant differences were found in APT SIs, MD, and MK among the four groups (P<0.05). Moderate to good relationships were found between the histologic grade of HCC and APT SI and MK (r=0.679, P<0.001 and r=0.539, P<0.001, respectively). The area under the ROC curves (AUCs) of APT SI, MK, and MD for differentiating low- from high-grade HCC were 0.890 (95%CI: 0.805–0.947), 0.765 (95%CI: 0.662–0.849) and 0.717 (95%CI: 0.611–0.808), respectively. Comparison of ROC curves showed a significantly higher AUC of APT SI compared with those of the DKI-derived parameters (P <0.05). Conclusion The APT imaging may be more accurate than DKI for predicting the histological grade of HCC.
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Affiliation(s)
- Baolin Wu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Fei Jia
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People's Republic of China
| | - Xuekun Li
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People's Republic of China
| | - Meng Zhang
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People's Republic of China
| | - Dongming Han
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People's Republic of China
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
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Ai Z, Han Q, Huang Z, Wu J, Xiang Z. The value of multiparametric histogram features based on intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the differential diagnosis of liver lesions. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1128. [PMID: 33240977 PMCID: PMC7576072 DOI: 10.21037/atm-20-5109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The present study analyzed whole-lesion histogram parameters from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) to explore the clinical value of IVIM histogram features in the differentiation of liver lesions. Methods In this retrospective study, 33 cases of hepatic hemangioma (HH), 22 cases of hepatic cysts (HC), and 34 cases of hepatocellular carcinoma (HCC) were underwent IVIM-DWI (b =0–600 s/mm2), which were confirmed pathologically and clinically. The data were processed by IVIM model to obtain the following quantitative indicators: perfusion fraction (f), slow diffusion coefficient (D), and pseudo-diffusion coefficient (or fast diffusion coefficient, D*). The region of interest in the largest solid part of the lesion was delineated for histogram analysis of the correlation between tissue image and lesion type. The relevant histogram parameters were obtained and statistically analyzed. The characteristic histogram parameters for HH, HC, and HCC were compared to find significantly different parameters. The diagnostic efficacies of these parameters for HH, liver cysts, and HCC were assessed using the receiver operating characteristic (ROC) curves. Results There were significant differences in the maximum diameter, maximum value, minimum value, mean, median, standard deviation, uniformity, skewness, kurtosis, volume, 10th percentile (P10) of D, and 90th percentile (P90) of D between the three groups (P<0.05). The maximum diameter, minimum value, entropy, and volume of D* differed significantly between the three groups (P<0.05). The maximum diameter, minimum value, mean, median, skewness, kurtosis, volume, P10, and P90 of f differed significantly between the three groups (P<0.05). The largest area under the ROC curve (AUC) for both D* and f was that of volume (AUC =0.883 for both). When 1438.802 was used as the volume cut-off, the sensitivity and specificity of volume in differentiating between HH and HC were 87.88 and 77.27, respectively, and the sensitivity and specificity of volume in differentiating between HC and HCC were 77.27 and 85.29. Conclusions A multiparametric histogram from IVIM-DWI magnetic resonance imaging (MRI) is an effective means of identifying HH, HC, and HCC that provides valuable reference information for clinical diagnosis.
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Affiliation(s)
- Zhu Ai
- Department of Radiology, Guangzhou Panyu Center Hospital, Guangzhou, China
| | - Qijia Han
- Department of Radiology, Guangzhou Panyu Center Hospital, Guangzhou, China
| | - Zhiwei Huang
- Department of Radiology, Guangzhou Panyu Center Hospital, Guangzhou, China
| | - Jiayan Wu
- Department of Radiology, Guangzhou Panyu Center Hospital, Guangzhou, China
| | - Zhiming Xiang
- Department of Radiology, Guangzhou Panyu Center Hospital, Guangzhou, China
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Regulski PA. Editorial for "Prognosis Prediction in Initially Diagnosed Multiple Myeloma Patients Using Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Multiecho Dixon Imaging". J Magn Reson Imaging 2020; 53:502-503. [PMID: 32864774 DOI: 10.1002/jmri.27352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Piotr A Regulski
- Center of Digital Science and Technology, Cardinal Stefan Wyszyński University in Warsaw, Warszawa, Poland
- Department of Dental and Maxillofacial Radiology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warszawa, Poland
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Jo A, Jung JY, Lee SY, Lee SE, Park H, Lee SE, Min CK. Prognosis Prediction in Initially Diagnosed Multiple Myeloma Patients Using Intravoxel Incoherent Motion-Diffusion Weighted Imaging and Multiecho Dixon Imaging. J Magn Reson Imaging 2020; 53:491-501. [PMID: 32812318 DOI: 10.1002/jmri.27321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multiparametric MRI provides complementary information for the diagnosis and management of multiple myeloma (MM). PURPOSE To evaluate the association of prognostic factors of MM and parameters derived from intravoxel-incoherent motion diffusion-weighted imaging (IVIM-DWI) and multiecho (ME) Dixon. STUDY TYPE Retrospective. POPULATION In all, 78 MM patients. FIELD STRENGTH/SEQUENCES T1 -weighted turbo spin-echo sequences (TSE), IVIM-DWI, ME 3D gradient echo sequence with multistep adaptive fitting at 3T. ASSESSMENT The region of interest (ROI) on the vertebral body was independently measured on four parametric maps (Dslow , Dfast and perfusion fraction [f], and proton-density fat-fraction [Ff] maps) by two readers. All patients were categorized into three groups based on the International Staging System (ISS). STATISTICAL TESTS Three groups were compared using analysis of variance (ANOVA) and post-hoc tests with Bonferroni correction. Logistic regression analysis was performed to predict the advancement of disease (early vs. advanced). Principal component analysis (PCA) was used to find the deterministic parameters. RESULTS Dslow and Ff were significantly different among ISS-1 (n = 38), ISS-2 (n = 22), and ISS-3 (n = 18) groups in both readers: 0.36, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), and 46%, 30%, and 15% for Ff (P < 0.05) in reader 1; 0.34, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), 43%, 27%, and 13.2% for Ff (P < 0.05) in reader 2, respectively. Dfast between ISS-3 and the other groups was significantly different in one reader only: 2.03, 2.29, and 2.85 × 10-3 mm2 /s (P < 0.05). There was no significant difference in f among the groups in both readers. Logistic regression by stepwise selection indicated Ff as the single most significant factor for differentiating early and advanced stages of MM with an accuracy of 76% and area under the curve (AUC) of 0.83 (P < 0.05). PCA revealed Ff, and Dslow as the deterministic parameters, with a cumulative proportion of 0.84. DATA CONCLUSION D slow and Ff are associated with the prognostic factor of MM. Level of Evidence 3 Technical Efficacy Stage 5. J. MAGN. RESON. IMAGING 2021;53:491-501.
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Affiliation(s)
- Aram Jo
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyerim Park
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Geng Z, Zhang Y, Wang S, Li H, Zhang C, Yin S, Xie C, Dai Y. Radiomics Analysis of Susceptibility Weighted Imaging for Hepatocellular Carcinoma: Exploring the Correlation between Histopathology and Radiomics Features. Magn Reson Med Sci 2020; 20:253-263. [PMID: 32788505 PMCID: PMC8424030 DOI: 10.2463/mrms.mp.2020-0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: No previous researches have extracted radiomics features from susceptibility weighted imaging (SWI) for biomedical applications. This research aimed to explore the correlation between histopathology of hepatocellular carcinoma (HCC) and radiomics features extracted from SWI. Methods: A total of 53 patients were ultimately enrolled into this retrospective study with MR examinations undertaken at a 3T scanner. About 107 radiomics features were extracted from SWI images of each patient. Then, the Spearman correlation test was performed to evaluate the correlation between the SWI-derived radiomics features and histopathologic indexes including histopathologic grade, microvascular invasion (MVI) as well as the expression status of cytokeratin 7 (CK-7), cytokeratin 19 (CK-19) and Glypican-3 (GPC-3). With SWI-derived radiomics features utilized as independent variables, four logistic regression-based diagnostic models were established for diagnosing patients with positive CK-7, CK-19, GPC-3 and high histopathologic grade, respectively. Then, receiver operating characteristic analysis was performed to evaluate the diagnostic performance. Results: A total of 11, 32, 18 and one SWI-derived radiomics features were significantly correlated with histopathologic grade, the expression of CK-7, the expression of CK-19 and the expression of GPC-3 (P < 0.05), respectively. None of the SWI-derived radiomics features was correlated with MVI status. The areas under the curve were 0.905, 0.837, 0.800 and 0.760 for diagnosing patients with positive CK-19, positive CK-7, high histopathologic grade and positive GPC-3. Conclusion: Extracting the radiomics features from SWI images was feasible to evaluate multiple histopathologic indexes of HCC.
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Affiliation(s)
- Zhijun Geng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare
| | - Shutong Wang
- Department of Hepatic Surgery, First Affiliated Hospital of Sun Yat-sen University
| | - Hui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Cheng Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Shaohan Yin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare
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Tao YY, Zhou Y, Wang R, Gong XQ, Zheng J, Yang C, Yang L, Zhang XM. Progress of intravoxel incoherent motion diffusion-weighted imaging in liver diseases. World J Clin Cases 2020; 8:3164-3176. [PMID: 32874971 PMCID: PMC7441263 DOI: 10.12998/wjcc.v8.i15.3164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/11/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
Traditional magnetic resonance (MR) diffusion-weighted imaging (DWI) uses a single exponential model to obtain the apparent diffusion coefficient to quantitatively reflect the diffusion motion of water molecules in living tissues, but it is affected by blood perfusion. Intravoxel incoherent motion (IVIM)-DWI utilizes a double-exponential model to obtain information on pure water molecule diffusion and microcirculatory perfusion-related diffusion, which compensates for the insufficiency of traditional DWI. In recent years, research on the application of IVIM-DWI in the diagnosis and treatment of hepatic diseases has gradually increased and has achieved considerable progress. This study mainly reviews the basic principles of IVIM-DWI and related research progress in the diagnosis and treatment of hepatic diseases.
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Affiliation(s)
- Yun-Yun Tao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yi Zhou
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ran Wang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xue-Qin Gong
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jing Zheng
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Cui Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology and Medical Research Center of Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Hectors SJ, Lewis S, Kennedy P, Bane O, Said D, Segall M, Schwartz M, Kim E, Taouli B. Assessment of Hepatocellular Carcinoma Response to 90Y Radioembolization Using Dynamic Contrast Material-enhanced MRI and Intravoxel Incoherent Motion Diffusion-weighted Imaging. Radiol Imaging Cancer 2020; 2:e190094. [PMID: 32803165 PMCID: PMC7398117 DOI: 10.1148/rycan.2020190094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 04/21/2023]
Abstract
PURPOSE To quantify diffusion and perfusion changes in hepatocellular carcinoma (HCC) induced by yttrium 90 (90Y) radioembolization and to assess the value of dynamic contrast material-enhanced (DCE) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for predicting HCC response. MATERIALS AND METHODS Institutional review board approval was obtained for this prospective study (clinical trial registry NCT01871545). Twenty-four participants with HCC (mean age, 69 years ± 9 [standard deviation], 18 men) underwent multiparametric MRI, including IVIM DWI and gadoxetic acid DCE MRI before (n = 24) and 6 weeks (n = 21) after radioembolization. IVIM DWI and DCE MRI histogram parameters were quantified in HCCs and liver parenchyma. HCC response was assessed by using modified Response Evaluation Criteria in Solid Tumors at 6 weeks and 6-12 months after radioembolization. Logistic regression analysis was used to evaluate the diagnostic performance of baseline MRI and clinical parameters for prediction of response. RESULTS Twenty-five HCCs were analyzed (mean size, 3.6 cm ± 1.9). Radioembolization resulted in significantly decreased perfusion (DCE MRI arterial flow, P = .002; IVIM pseudodiffusion coefficient [D*], P = .014). Multivariate logistic regression selected combined serum α-fetoprotein and portal flow (F p ) skewness (area under the curve [AUC] = 0.924) and combined D* standard deviation and F p kurtosis (AUC = 0.916) for prediction of objective and complete response at 6 weeks, respectively. Standard deviation of DCE MRI parameter arterial fraction was selected as the optimal predictor for complete response at 6-12 months (AUC = 0.857). CONCLUSION Diffusion and perfusion MRI can be used to evaluate the response of HCC to radioembolization. Pretreatment DCE MRI histogram parameters may be useful for radioembolization treatment stratification. Supplemental material is available for this article. © RSNA, 2020.
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Shi G, Han X, Wang Q, Ding Y, Liu H, Zhang Y, Dai Y. Evaluation of Multiple Prognostic Factors of Hepatocellular Carcinoma with Intra-Voxel Incoherent Motions Imaging by Extracting the Histogram Metrics. Cancer Manag Res 2020; 12:6019-6031. [PMID: 32765101 PMCID: PMC7381091 DOI: 10.2147/cmar.s262973] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose To predict multiple prognostic factors of HCC including histopathologic grade, the expression of Ki67 as well as capsule formation with intravoxel incoherent motions imaging by extracting the histogram metrics. Patients and Methods A total of 52 patients with HCC were recruited with the MR examinations undertaken at a 3T scanner. Histogram metrics were extracted from IVIM-derived parametric maps. Independent student t-test was performed to explore the differences in metrics across different subtypes of prognostic factors. Spearman correlation test was utilized to evaluate the correlations between the IVIM metrics and prognostic factors. ROC analysis was applied to evaluate the diagnostic performance. Results According to the independent student t-test, there were 18, 4, and 8 IVIM-derived histogram metrics showing the capability for differentiating the subtypes of histopathologic grade, Ki67, and capsule formation, respectively, with P-values of less than 0.05. Besides, there existed a lot of significant correlations between IVIM metrics and prognostic factors. Finally, by integrating different histogram metrics showing significant differences between various subgroups together via establishing logistic regression based diagnostic models, greatest diagnostic power was obtained for grading HCC (AUC=0.917), diagnosing patients with highly expressed Ki67 (AUC=0.861) and diagnosing patients with capsule formation (AUC=0.839). Conclusion Multiple prognostic factors including histopathologic grade, Ki67 expression status, and capsule formation can be accurately predicted with assistance of histogram metrics sourced from a single IVIM scan.
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Affiliation(s)
- Gaofeng Shi
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Xue Han
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Qi Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Yan Ding
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Hui Liu
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Yunfei Zhang
- Department of Research Collaboration Hospital (MRI), Central Research Institute, United Imaging Healthcare, Shanghai 201800, People's Republic of China
| | - Yongming Dai
- Department of Research Collaboration Hospital (MRI), Central Research Institute, United Imaging Healthcare, Shanghai 201800, People's Republic of China
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Wang GZ, Guo LF, Gao GH, Li Y, Wang XZ, Yuan ZG. Magnetic Resonance Diffusion Kurtosis Imaging versus Diffusion-Weighted Imaging in Evaluating the Pathological Grade of Hepatocellular Carcinoma. Cancer Manag Res 2020; 12:5147-5158. [PMID: 32636677 PMCID: PMC7334009 DOI: 10.2147/cmar.s254371] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/21/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the diagnostic efficacy of diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (DWI) for pathological grading. Methods From December 2015 to January 2017, consecutive patients suspected of having hepatocellular carcinoma (HCC) without prior treatment were prospectively enrolled in this study. MRI examinations were performed before surgical treatment. HCC patients confirmed by surgical pathology were included in the study. The mean diffusivity (MD) values, mean kurtosis (MK) values, and apparent diffusion coefficient (ADC) were calculated. The differences and correlations of these parameters among different pathological grades were analyzed. The diagnostic efficiency of DKI and DWI for predicting high-grade HCC was evaluated by receiver operating characteristic (ROC) curves. Logistic regression analyses were used to evaluate the predictive factors for pathological grade. Results A total of 128 patients (79 males and 49 females, age: 56.9±10.9 years, range, 32–80) with primary HCC were included: grade I: 22 (17.2%) patients, grade II: 37 (28.9%) patients, grade III: 43 (33.6%) patients, grade IV: 26 (20.3%) patients. The MK values of stage I, II, III, and IV were 0.86±0.13, 1.06±0.11, 1.27±0.17, and 1.57±0.13, respectively. The MK values were significantly higher in the high-grade group than in the low-grade group and were positively correlated with pathological grade (rho =0.7417, P<0.001). The MK value demonstrated a larger area under the curve (AUC), with a value of 0.93 than the MD value, which had an AUC of 0.815 (P<0.001), and ADC, which had an AUC of 0.662 (P=0.01). The MK value (>1.19), ADC (≤1.29×10–3 mm2/s), and HBV (+) were independent predictors for the pathological grade of HCCs. Conclusion The MK values derived from DKI and the ADC values obtained from traditional DWI were more valuable than the MD values in predicting the histological grade of HCCs and could potentially guide clinical treatment before surgery.
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Affiliation(s)
- Guang-Zhi Wang
- Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China.,Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang 261053, People's Republic of China
| | - Ling-Fei Guo
- Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
| | - Gui-Hua Gao
- Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
| | - Yao Li
- Zhucheng People's Hospital Affiliated to Weifang Medical University, Weifang 262200, People's Republic of China
| | - Xi-Zhen Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang 261053, People's Republic of China
| | - Zhen-Guo Yuan
- Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China.,Department of MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan 250021, People's Republic of China
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